Director, Field Reimbursement -Northeast

Pacira Pharmaceuticals, Inc.•UNAVAILABLE, UNAVAILABLE

22h•Remote

About The Position

The Director, Field Reimbursement is a customer-facing role reporting to the Executive Director of Market Access & Reimbursement, responsible for managing defined accounts within a specified region in the Non-Opioid Pain Therapeutic area. This role supports specialty buy-and-bill therapies by driving product reimbursement and coverage, removing access barriers, and partnering with internal and external stakeholders to execute strategic plans. Key responsibilities include representing Pacira and the value of its products, facilitating understanding of reimbursement services, building relationships with key healthcare influencers, and serving as the internal expert on medical coding, billing, and reimbursement.

Requirements

Bachelor’s degree from an accredited college or university in Health Policy, Finance, Business, or other related fields.
Minimum of 8+ years related experience in the healthcare industry.
Minimum of 5 years of relevant reimbursement experience, particularly managing targeted reimbursement relationships.
Minimum of 3 years management experience
Excellent ability to recruit, hire, train, coach and retain experienced managers in the reimbursement field.
High emotional intelligence in managing multiple business initiatives and cross-functional relationships.
Excellent planning, organizational and project management skills
General payer policy knowledge including managed care and Medicare/Medicaid
Foundational knowledge of benefit verifications and prior authorization requirements
Knowledge of Reimbursement and billing processes within the physician office
Ability to review clinical information in patient charts, understand and interpret payer policy to provide guidance to HCP offices on how they may proceed in filling out prior authorization/formulary exception/appeals documentation.
Specific knowledge of specialty product buy and bill, coding, and in office best practices on program management.
Proven track record overseeing or managing medical billing and coding including appeals, denials, and single case rates.
Excellent written and verbal English communication skills including presentation skills to groups of all sizes and at executive levels.
Demonstrated ability to partner, communicate, and accomplish goals across organization without direct reporting structure.
Proven ability to think strategically and succeed with limited structure and direction.
Proven problem-solving, analytic and negotiation skills with high value contracts and partnerships.
Extensive, proven reimbursement experience
Demonstrated understanding of CMS, Commercial payment models, and trends.
Valid driver’s license in the state in which you reside.
The Director, Field Reimbursement, must reside within the region that they oversee.

Nice To Haves

Financial/budgetary experience preferred.

Responsibilities

Manage a team of Field Reimbursement Managers (FRM) for a given region providing support and guidance to create optimal reimbursement pathways for our customer base.
Recruit, hire, train, develop and manage qualified provider-focused FRMs.
Coach and develop FRMs to function in a highly effective, consistent manner while ensuring legal and regulatory compliance. Prepare and deliver performance reviews and Field Coaching Reports (FCR) to FRMs.
Manage the FRM expense budget within appropriate guidelines and ensure all FRM performance metrics are captured and reported in a timely manner.
Act as an extension of EXPAREL & ZILRETTA, provide live one-on-one coverage support.
Offer assistance from physician order to reimbursement, supporting the entire Reimbursement journey through payer prior authorization to appeals/denials requirements procedures and forms.
Review patient-specific information in cases where the site has specifically requested assistance in resolving any issues or coverage challenges.
Review patient insurance benefit options.
Coordinate with Pacira’s patient support services programs representatives.
Educate physician office staff on the use of Pacira’s call center support services, including web-based provider programs.
Provide information on relevant Reimbursement topics related to our Pacira’s portfolio.
Serve as payer expert for defined geography and able to communicate changes to key stakeholders in a timely manner.
Provide office support in accurate coding and billing for Pacira’s portfolio.