Field Reimbursement Manager

Sobi•Waltham, MA

21h•$115,000 - $150,000

About The Position

Introduction/Purpose: Reporting to the Director of Field Reimbursement, the Field Reimbursement Manager (FRM) is an important member of the Sobi Market Access team. The FRM is a field-based, non-promotional resource for health systems, institutions, hospitals, and HCP practices/groups that serves as the key to help unlock patient access and resolve reimbursement issues. The FRM is a critical component of customer support and will rely on strong problem-solving skills to provide an outstanding customer experience for patients, providers and staff to ease the burden of access and improve access awareness to Sobi therapies. He/she will do this by: · Customer Engagement: Maintain a targeted account list and proactively engage customers through both virtual and in-person interactions Relationship Management: Build and maintain strong relationships with key stakeholders including medication access teams, pharmacy, office/practice managers, and reimbursement/procurement departments Subject Matter Expertise: Serve as a reimbursement and access expert across all payer channels (Commercial, Medicare, Medicaid, Government), identifying compliant solutions to access challenges Access & Reimbursement Support: Educate customers on benefit verification, prior authorizations, appeals, specialty pharmacy/distribution models, CPT coding, and J-codes Cross-Functional Collaboration: Act as a bridge between customers, patient services (HUB), sales, and account teams to resolve access barriers and escalations HUB Partnership: Collaborate with Doptelet and Vonjo Connect HUBs and case managers to compliantly address escalations and access issues for hub patients Market Insights: Provide feedback and insights to internal stakeholders to inform strategy and improve patient access solutions Territory Collaboration: Partner closely with local cross-functional colleagues to support accounts within a defined geography Demonstrates deep knowledge in: 1. Reimbursement and access across all channels (Commercial, Medicare, Medicaid, Exchange and Government)and is the subject matter expert of the payers in the markets they will support 2. All phases of specialty distribution, specialty pharmacy core services to assist with supporting access and product procurement healthcare structures, payment systems, and reimbursement methodology 3. Works collaboratively with internal and external business partners to win—Thinks and acts as a team; understands the nature and interdependencies of a matrix team environment and can effectively work cross-functionally to seize opportunities, resolve payer issues, improve customer experience, avoid bureaucracy, and maximize outcomes of strategies and key actions. Internal Partners: Sales, Marketing, Patient Services, Trade Team, National and Regional Account Directors, Medical Affairs · External Partners: Builds relationships with: Health Systems, Institutions, Hospitals, HCPs, practice managers, reimbursement/access departments, and other customers who support access & reimbursement 4. Exhibits strong problem-solving skills related to complex patient access challenges across payers and specialty pharmacies 4. Educates health systems, institutions, hospitals, and HCP office staff about: · Patient Service Program options to optimize patient access to Sobi’s products · Prior authorization requirements, coverage status, and payer appeals requirements, processes, and timelines 5. Comprehends and effectively demonstrates ability to conduct field-based customer support related to payer coverage and payment process (coverage navigation & specialty pharmacy fulfilment) 6. Adheres to all relevant regulatory and Sobi compliance & ethics guidelines and a willingness to coach to ensure a culture of compliance

Requirements

A minimum of a B.A/B.S. required
A minimum five (5) years of work experience in Pharmaceuticals/Biotech/Medical Device with relevant understanding of the following areas:
Patient journey navigation
Payer coverage polices
Pharmacy benefit reimbursement
Specialty pharmacy and distribution
In office dispensing accounts
Hub and Patient Services
Industry Knowledge – proficient understanding of the pharmaceutical industry, disease state and drug distribution process (e.g., medical, specialty pharmacy, managed care systems, etc.)
Understanding of Medicare and Medicaid drug coverage and current and pending changes to drug coverage benefits
Technical Expertise (Reimbursement and Patient Access) —Demonstrates strong technical expertise
Reimbursement and patient access knowledge with the ability to effectively convey knowledge to key stakeholders.
Computer Skills – Ability to effectively use technology to support escalation work internal and external portals and databases
Advanced Microsoft Excel skills that support analysis of large databases and manage a high volume of data
Analytical Skills – Ability to analyze and leverage data/reports to identify trends and opportunities
Demonstrates Passion, high energy, excitement, and a sense of urgency toward organizational purpose and values.
Cultivates High IMPACT Partnerships with internal and external partners—Develops meaningful partnerships based on Sobi Core Values striving to earn and preserve the trust, respect, and admiration of all stakeholders.
Values & Unlocks Collaboration—Cultivates an atmosphere of interdependence, collaboration, and reciprocal communication that creates a winning environment that inspires all to demand the ‘best’ from themselves because winning is fun and fulfilling.
Business Savvy—Demonstrates a clear understanding of the current territory business situation, marketplace, and environment
Understand HIPAA rules and regulations related to patient privacy
Strong written and verbal communications as well as presentation skills

Nice To Haves

Reimbursement experience
Hematology/Oncology experience
Demonstrated ability to work accounts; specifically working to identify, engage and build relationships with key reimbursement contacts, access personnel and practice managers within identified accounts.

Responsibilities

Maintain a targeted account list and proactively engage customers through both virtual and in-person interactions
Build and maintain strong relationships with key stakeholders including medication access teams, pharmacy, office/practice managers, and reimbursement/procurement departments
Serve as a reimbursement and access expert across all payer channels (Commercial, Medicare, Medicaid, Government), identifying compliant solutions to access challenges
Educate customers on benefit verification, prior authorizations, appeals, specialty pharmacy/distribution models, CPT coding, and J-codes
Act as a bridge between customers, patient services (HUB), sales, and account teams to resolve access barriers and escalations
Collaborate with Doptelet and Vonjo Connect HUBs and case managers to compliantly address escalations and access issues for hub patients
Provide feedback and insights to internal stakeholders to inform strategy and improve patient access solutions
Partner closely with local cross-functional colleagues to support accounts within a defined geography

Benefits

Competitive compensation for your work
Generous time off policy
Summer Fridays
Opportunity to broaden your horizons by attending popular conferences
Emphasis on work/life balance
Collaborative and team-oriented environment
Making a positive impact to help ultra-rare disease patients who are in need of life saving treatments
A competitive 401(k) match to support your financial future.
Tuition and wellness reimbursements to invest in your personal and professional growth.
A comprehensive medical, dental, and vision package to prioritize your health and well-being.
Additional recognition awards to celebrate your achievements.