Field Reimbursement Manager - Botox Therapeutic
About The Position
The Field Reimbursement Manager (FRM) shares expertise and educates healthcare providers, administrative staff, revenue cycle management teams, and institutional leadership on Medical and Pharmacy benefits, Buy & Bill and Specialty Pharmacy acquisition, payer policy, appropriate patient identification, clinical documentation, benefit investigation results, prior authorizations, billing, coding, patient tracking, claim submission, reconciliation management, patient financial savings programs, retreatment, and denial and appeal processes for approved BOTOX Therapeutics indications. The FRM identifies barriers that may impede or delay appropriate treatment or prevent optimal patient outcomes. The role educates accounts on the BOTOX treatment process, appropriate reimbursement, payer landscapes, and need-based tools that support patient access, including HUB services, patient savings programs, payer coverage details, and acquisition pull-through initiatives. The FRM uses analytical and problem-solving skills to identify access and reimbursement barriers, uncover root causes, and offer actionable, customized solutions in complex healthcare environments. The FRM monitors and shares updates on regional and national payers, including changes to medical policies, prior authorization requirements, and product acquisition, using compliant methods. The role collaborates with internal stakeholders across Market Access, Center of Excellence, Sales, Marketing, Training, Compliance, Trade, and Specialty Pharmacy groups, while providing customer feedback and sharing challenges and potential solutions. The position establishes respectful working relationships with healthcare professionals, staff, and business decision makers, including C-suite executives. It requires influencing across functions, leading without authority, communicating complex information and difficult facts professionally, contributing to Field Input Teams, and planning and prioritizing work with effective follow-up and anticipation of problems. All work must comply with AbbVie internal requirements and applicable regulations. This is a field-based position covering San Francisco and San Jose, California. Candidates should live within a reasonable distance of the primary city. Travel is 50% of the time; some overnight travel may be required. Talent will be hired at a level commensurate with experience.
Requirements
- A minimum of 5–7 years of proven success in a healthcare-related field.
- Bachelor’s degree required.
- Proven record of comprehensive work with accounts at all levels.
- Experience with payer or insurance coverage, including Medicare, Medicare Advantage, Commercial, and Medicaid plans.
- Well-developed verbal and written communication skills, including in-person and virtual presentation skills for complex information and processes.
- Proven and consistent competence in problem solving, gaining access, resource mastery, achieving tangible results, overcoming adversity, collaboration, and managing complexities.
- Demonstrated empathy, critical thinking, curiosity, persistence, reliability, and resourcefulness.
- Strong history of leadership within the current role.
- Technology and analytical skills, including Salesforce, virtual meetings, Excel, and report interpretation.
- Ability to drive a personal auto or company car or truck, or powered material-handling equipment.
- Valid driver’s license, ability to pass a pre-employment drug screening test, and ability to meet safe driving requirements.
- Ability to travel adequately to cover the territory and attend training and meetings; some overnight travel may be required.
Nice To Haves
- Previous experience in Sales, District Management, Hospital, Managed Markets, Access and Reimbursement, or a healthcare practice.
- Knowledge of Lean Six Sigma principles.
- Exposure to physician-administered injectables, CPT and/or J-code reimbursement, Specialty Pharmacy and Buy & Bill acquisition, benefit verifications, prior authorizations, claim assistance, appeals, payer policies, and HUB services.
Responsibilities
- Educate accounts on the BOTOX treatment process, appropriate reimbursement, and the payer landscape.
- Explain Medical and Pharmacy benefits, Buy & Bill and Specialty Pharmacy acquisition, payer policies, patient identification, clinical documentation, benefit investigation results, prior authorizations, billing, coding, patient tracking, claim submission, reconciliation, patient financial savings programs, retreatment, and denial and appeal processes for approved BOTOX Therapeutics indications.
- Identify access and reimbursement barriers, uncover their root causes, and offer actionable solutions to support appropriate care and patient outcomes.
- Monitor regional and national payer updates, including changes or barriers in medical policy, prior authorization requirements, and product acquisition, and exchange critical information using compliant methods.
- Collaborate and act as an information liaison among internal stakeholders, including Market Access, Center of Excellence, Sales, Marketing, Training, Compliance, Trade, and Specialty Pharmacy groups.
- Provide customer feedback to AbbVie stakeholders about approval requirements and barriers to access to care.
- Educate accounts about need-based patient access tools, including HUB services, patient savings programs, payer coverage details, and acquisition pull-through initiatives.
- Establish and maintain respectful relationships with healthcare professionals, staff, and business-oriented decision makers, including C-suite executives.
- Lead without authority, communicate with diverse groups, influence across functions, and build consensus on patient solutions.
- Deliver crucial conversations professionally, including when communicating difficult information or facts.
- Participate proactively in Field Input Teams and share customer challenges and potential solutions.
- Plan and prioritize effectively, follow up, and anticipate problems.
- Conduct all work in compliance with AbbVie internal requirements and applicable regulatory requirements.
Benefits
- Paid time off, including vacation, holidays, and sick time.
- Medical, dental, and vision insurance for eligible employees.
- 401(k) for eligible employees.
- Eligibility to participate in long-term incentive programs.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
