Field Reimbursement Manager

Valeris•Remote, Virginia, VA

About The Position

Valeris is seeking a Field Reimbursement Manager (FRM) to help reduce barriers to patient access to medications. The FRM resolves access issues, educates healthcare provider offices on billing and coding, and provides reimbursement education at relevant sites of care. The role works with office support, billing and coding staff, third-party vendors, client teams, and other stakeholders, and serves as a subject-matter expert on medical-benefit reimbursement, access, coverage, prior authorizations, and appeals. The position may be based in Maryland, Delaware, West Virginia, Virginia, North Carolina, South Carolina, or Georgia. It may require up to 10% travel, with additional travel for national meetings, training programs, and POAs. The work takes place in a professional office environment and uses standard office equipment. The role involves regular talking or hearing, frequent prolonged sitting, typing, handling or feeling objects, and reaching with hands and arms. Candidates are preferred to type at least 35 words per minute with 97% accuracy. Valeris offers eligible full-time employees health coverage and other support, retirement savings, paid leave and holidays, and opportunities for advancement and professional growth. Employment offers are contingent on completion of a background check and, depending on the position, a drug screen.

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.
Valid driver’s license for travel when required.

Nice To Haves

Direct experience with specialty dermatology products.
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 verification, prior authorization and pre-determination requirements, and reimbursement processes across different 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.
Residence in Maryland, Delaware, West Virginia, Virginia, North Carolina, South Carolina, or Georgia.
Ability to type at least 35 words per minute with 97% accuracy.
Flexibility to travel as needed.

Responsibilities

Resolve complex patient access issues by coordinating with the Hub, provider offices, and the client field team.
Partner with the client’s Sales Team, Payer Teams, Marketing, healthcare providers, and specialty pharmacies to develop and advance strategic reimbursement support approaches.
Educate healthcare providers and office staff about 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 providers through prior authorization and appeals, including required documentation, payer-specific requirements, and communication of outcomes.
Manage daily activities that support 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 provide education to reduce future reimbursement hurdles.
Coordinate with representatives of client patient support services programs regarding patient cases and claim issues.
Educate office staff on client patient assistance and reimbursement support services, including web-based provider programs and tools, and provide information on relevant reimbursement topics.
Monitor regional payer policies to support appropriate product coding, coverage, and payment.
Help providers understand local payer coverage and reimbursement trends through educational breakfast, lunch, and dinner programs.
Lead product reimbursement training for sales teams as appropriate.
Communicate reimbursement concerns and issues to internal stakeholders, including Sales and Managed Markets.
Monitor national and regional payer trends and changes.
Work with the Managed Markets team 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 (EAP) 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, with immediate vesting.
Paid Time Off (PTO) and sick leave.
Nine paid holidays and two floating holidays.
Opportunities for advancement and personal and professional growth.
A challenging, stimulating work environment that encourages new ideas.
An inclusive workplace and mission-driven culture.