Field Reimbursement Manager, Retina (South Central)

Thea Pharma•Houston, TX

1d•Remote

About The Position

The Field Reimbursement Manager (FRM) – Retina is a field-based specialist responsible for addressing access, reimbursement, and coverage barriers for our retina portfolio. You will serve as the primary strategic expert for retina practices, ophthalmologists, and billing staff—helping them navigate complex insurance processes, prior authorizations, appeals, and "buy-and-bill" procedures. As a launch-focused FRM, you will be instrumental in executing the market access readiness strategy for our newly launched retina therapy. You will proactively prepare accounts for launch, accelerating the time-to-treatment by mitigating initial billing uncertainties, helping practices secure early coverage, and instilling confidence in our reimbursement processes. This role does not involve commercial sales or promoting the clinical benefits of the drug. You will partner with your internal Matrix team to ensure that practices are prepared and comfortable with Thea and our new products. Partner with Compliance, Finance, Distribution, and Training to ensure coordinated customer engagement and successful execution of reimbursement strategies. This role reports to the Director of Retina Field Reimbursement.

Requirements

2+ years of direct experience executing buy-and-bill product launches in the specialty biologic or pipeline space (Ophthalmology/Retina launch experience heavily preferred).
Deep understanding of Medicare Part B (including Average Sales Price / ASP models), Medicare Part D, commercial insurance, Medicaid, and specialized Hub reimbursement services.
Demonstrated ability to navigate the fluid, fast-paced environment of a product launch, where payer policies are evolving daily.
Exceptional presentation skills and the ability to explain complex financial/billing rules in simple terms.
Strong problem-solving skills for resolving rejected claims.
Strict adherence to healthcare compliance regulations, including HIPAA, OIG guidance, and individual company compliance policies.
Demonstrated success partnering in a matrixed environment.
Extensive proficiency with Microsoft Office (Word, Excel, PowerPoint, Teams, Outlook) and CRM platforms.

Nice To Haves

Prior experience in Ophthalmology/Retina is highly preferred due to the unique, high-volume workflow of retina clinics.
An advanced degree or coding certification (e.g., CPC, CHC, PACs) is a plus.
6+ years experience supporting buy-and-bill products required in ophthalmology, rare disease, or specialty pharmaceuticals preferred.

Responsibilities

Conduct intensive pre-launch and immediate post-launch billing and coding workshops for high-volume retina practices to minimize administrative delays.
Educate practices on how to properly submit claims using new permanent J-Code HCPCS codes without an established ASP and lead the smooth operational transition once the ASP is established.
Closely monitor initial claims submissions for early-adopting practices to identify and immediately troubleshoot systemic payer rejections or clearinghouse formatting errors.
Serve as the subject matter expert on reimbursement, coverage, and access for complex retina practices, ASCs (Ambulatory Surgery Centers), and hospital outpatient departments.
Educate clinic staff, specialized billing personnel, and practice managers on local/national payer policies, prior authorization requirements, claims submission processes, and specific coding (J-codes, CPT codes, ICD-10).
Analyze and help resolve complex reimbursement issues, including denied claims, underpayments, and complex appeals, by providing compliant guidance.
Guide practices on the operational mechanics of the buy-and-bill model, specialty pharmacy fulfillment, inventory management, and utilizing co-pay or patient assistance programs.
Actively track and map the rollout of local commercial and Managed Medicaid policy determinations for the new product, relaying real-time market updates back to internal launch teams.
Ensure clinic staff are fully trained on how to utilize the new product's Patient Support Program (Hub) for rapid benefits verification and prior authorization support.
Partner compliantly with Field Sales, Key Account Managers, and internal Patient Support Services (Hubs) to ensure a seamless access experience for provider offices.