Field Reimbursement Manager

Overview

The Field Reimbursement Manager (FRM) position is a frontline member of Keenova Access and Reimbursement Team. The role aims to minimize access and reimbursement barriers for patients and providers by assisting provider offices to help patients access care.

Within their geography, the FRM provides access and reimbursement education to physician office personnel, billing staff/companies, HCPs, and others involved in using the product, with the goal of increasing access to care. The FRM focuses on Keenova's Specialty therapies, how to buy and bill Keenova products, acquisition through specialty pharmacies, and educating on office processes. FRMs also support provider offices reactively by providing education and guidance in response to prior authorization denials, claim denials, and underpayments.

The FRM will leverage data analytic tools to minimize delays in treatment by working with internal and external customers.

Provider Account Support

• Subject matter expert for all reimbursement/access and acquisition logistical aspects of a high touch biologic medication for an orphan disease and testosterone products with multiple acquisition options within a changing payer landscape. Includes payer policies, prior authorization requirements, denial and appeal process, peer to peer, and other education required to navigate access for the appropriate patients.
• Assist HCP offices with questions related to Buy/Bill BI management. Educate/assist with Specialty Pharmacy understanding, expectations and logistics. Continually educate office staff on appropriate steps, emphasize chart documentation, keep offices up to date on payer policies for Keenova products, and triage issues to the appropriate HUB and SP.
• Primary responsibilities include:
  Managing patient assistance and reimbursement support services offered to providers and related to patient access to buy/bill products;
  Coordinating with Keenova's patient support services program representatives;
  Educating office staff on the use of Buy/Bill products, patient assistance, and reimbursement support services;
  Participating in sales training related to product reimbursement;
  Utilizing data to analyze acquisition challenges from SP, Specialty Distributors, and Title sales;
  Assisting new offices from a reimbursement perspective to inform them about reimbursement issues and MARC approved resources;
  Acting in a compliant manner at all times.

Specialty Pharmacy (SP) Support

• FRMs work closely with external and internal customers to troubleshoot SP-related issues and coordinate with the NAE partner to manage customer issues with SPs.
• SP experience is critical; each FRM should be an expert in SP logistics and operations.
• FRMs analyze data and translate it into actionable steps to facilitate patient access to Keenova products.
• Work with SPs to understand logistical issues and provide MARC approved resources to facilitate patient access; communicate with SPs to resolve issues at the SP.
• Identify gaps in SP process knowledge for accounts and provide education for the account and physician.
• Develop short and long-term account plans for key accounts to smooth the process of acquiring drug and optimize the patient journey.

Internal Partnerships

• Provide consistent, reliable, timely, and high-quality support of the field and all internal commercial functions.
• Serve in a leadership role to the field by establishing a solutions-oriented approach; work with Sales Representatives/ASMs to build and execute local plans to overcome barriers to Buy/Bill product access. Identify targeted accounts where the FRM will assist with product acquisition or SP dispense.
• Partner with ASMs to build local business plans; participate in district business reviews as the expert resource on reimbursement from regional, district, state, and local perspectives.
• Provide actionable feedback on support programs such as Helpline, copay card, and SP performance to guide changes to improve access.
• Educate internal customers on managed market dynamics specific to SPs/SDs and local payer issues; track customer trends to inform internal decisions (e.g., healthcare policy changes).
• Proactively use…