Field Reimbursement Manager

Valeris • Remote, Texas, TX

1d

About The Position

The Field Reimbursement Manager (FRM) helps eliminate patient access barriers and increase access to medications. The role resolves patient access issues, educates healthcare provider offices on appropriate billing and coding, and provides education at relevant sites of care. The FRM works directly with office support staff, billing and coding staff, third-party vendors such as HUBs, copay card and patient assistance programs, and other stakeholders supporting access to client therapies. The FRM serves as a subject-matter expert on medical benefit reimbursement, access, coverage, prior authorization, and appeals. The role may be based in Arizona, New Mexico, Northern Texas, or Oklahoma, with preference for candidates residing in those states. Travel may be required, including up to 10% and additional travel for national meetings, training programs, and POAs. The position operates in a professional office environment and routinely uses standard office equipment.

Requirements

• Associate’s degree or higher in a related field, or equivalent market experience.
• At least 3 years of experience in the pharmaceutical or healthcare industry, working with specialty products, HUBs, payers, healthcare providers, or a related area.
• Specific practice management, billing, and/or coding experience for drugs, biologicals, or devices.
• General payer policy knowledge, including public and private payers.
• Foundational knowledge of medical benefit verifications, prior authorization and pre-determination requirements, and reimbursement processes across various sites of care.
• Demonstrated ability to provide virtual and field-based reimbursement support and education.
• Experience with prior authorizations, reimbursement billing, coding, and appeals.
• Knowledge of commercial payer, Medicare, and Medicaid structures, systems, and reimbursement processes.
• Strong stakeholder engagement and communication skills.
• Valid driver’s license for required travel.
• Ability to talk and hear; frequently sit for long periods, use hands to type, handle, or feel, and reach with hands and arms.
• Preference for candidates able to type at least 35 words per minute with 97% accuracy.

Nice To Haves

• Direct experience with specialty dermatology products.
• Residence in Arizona, New Mexico, Northern Texas, or Oklahoma.
• Flexibility to travel as needed.

Responsibilities

• Resolve complex patient access issues by working across the HUB, provider offices, and client field team.
• Partner with the client’s Sales Team, Payer Teams, Marketing, healthcare providers, and Specialty Pharmacies to develop and implement reimbursement support approaches that increase individual patients’ access to therapy.
• Educate healthcare providers and office staff on Patient Support Programs, program operating policies, and the patient journey.
• Lead onsite education for healthcare provider offices on program business rules, payer coverage, miscellaneous J-codes, and other reimbursement activities as needed.
• Guide healthcare providers through prior authorization and appeals, including required documentation, payer-specific requirements, and communicating outcomes.
• Manage daily activities supporting appropriate patient access to client products across relevant sites of care, as an extension of HUB reimbursement support services.
• Review product billing and coding, help resolve reimbursement issues, and educate providers to prevent future reimbursement hurdles.
• Coordinate patient cases and claim issues with representatives of the client’s patient support services programs.
• Educate office staff on patient assistance and reimbursement support services, including web-based provider programs and tools, and provide information on relevant reimbursement topics.
• Conduct regional payer policy surveillance to support appropriate coding, coverage, and payment of client products.
• Educate providers about local payer coverage and reimbursement trends through breakfast, lunch, and dinner programs.
• Lead sales training related to product reimbursement, as appropriate.
• Communicate reimbursement concerns and issues to internal stakeholders, including Sales and Managed Markets.
• Monitor national and regional payer trends and changes.
• Collaborate with Managed Markets to escalate potential payer issues.
• Comply with HIPAA and program guidelines.
• Meet training deadlines for corporate policies and procedures governing access to confidential data.
• Follow all SOPs and BRDs consistently.

Benefits

• Medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing toward premium costs.
• Telehealth and Employee Assistance Program services.
• Company match on Health Savings Account contributions.
• Free basic life and AD&D coverage equal to annual earnings, with a minimum of $50,000 and a maximum of $300,000.
• Company-paid short-term disability coverage, with the option to purchase long-term disability.
• 401(k) Retirement Savings Plan with 100% match on the first 5% contributed and immediate vesting.
• Paid Time Off (PTO) and sick leave.
• Nine paid holidays plus two floating holidays.
• Opportunities for advancement and personal and professional growth.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree