Field Reimbursement Manager - GI - Orange County, CA

6077-Johnson & Johnson HCS Legal Entity•Irvine, CA

3d•Onsite

About The Position

Johnson & Johnson Innovative Medicine’s Patient Engagement and Customer Solutions (PECS) team is hiring a field-based Field Reimbursement Manager for the Orange County, California territory. PECS works to create personalized, seamless, and supportive patient experiences that help patients start and remain on treatment. The role serves as the primary field-based lead for educating healthcare providers and their office staff and resolving issues related to patient access to J&J Immunology therapies. The manager spends up to 50% of their time on-site with healthcare providers, assessing education needs and facilitating collaboration with stakeholders. The position provides expertise and education on reimbursement and access, including coverage, prior authorization and appeals, claims submission, reimbursement processes, procedures, and payer coding requirements. The manager collaborates with field teams and internal functions, supports practices in resolving patient access and affordability challenges, and develops strong relationships across assigned Immunology accounts. The role also requires maintaining knowledge of payer and market dynamics, hub and specialty distribution channels, and access across pharmacy and medical benefits, including buy-and-bill and assignment of benefit.

Requirements

Bachelor’s degree; healthcare or business/public administration is preferred.
At least 5 years of relevant professional experience.
Account management and/or reimbursement experience in a provider office setting, including building strong customer relationships.
Demonstrated expertise with pharmacy and medical/buy-and-bill benefits, coding, and billing.
Reimbursement or relevant managed care experience, including revenue cycle, buy-and-bill, prior authorization, coding, and appeals processes.
Ability to establish relationships, collaborate, and influence across a matrix organization.
Problem-solving ability to navigate challenging access scenarios and identify timely, efficient solutions.
Strong written and verbal communication skills and efficient follow-through.
Experience working with patient support hub services.
Valid U.S. driver’s license and driving record that complies with company standards.
Ability to consistently maintain up to 50% travel.
Permanent residence in the listed territory.

Nice To Haves

Advanced business degree (MBA) or public health degree (MPH).
Immunology disease-state experience.
Advanced degree and/or relevant certifications in prior authorization and/or billing and coding.
Strong market access acumen related to payer approval processes and business acumen.
Understanding of Medicare, Medicaid, and private payer initiatives affecting pharmaceutical and biotechnology product reimbursement.
Excellent technical knowledge of payer policy, including reimbursement coding, coverage, and payment.
Demonstrated competence using Salesforce.com CRM, Microsoft Word, and Excel.
Commitment to learning emerging technologies such as AI through exploration, iteration, and applying new tools over time.

Responsibilities

Educate healthcare providers on product coverage, prior authorizations and appeals, reimbursement processes, claims submissions, procedures, and payer coding requirements for core and launch products.
Collaborate with field support team members, including sales representatives and key account managers, and serve as the local team’s reimbursement expert.
Address critical patient access and affordability issues with a sense of urgency.
Partner with managed care colleagues to understand current policies and potential future changes.
Provide field-based reimbursement and access support, education, and creative problem-solving in accordance with FRM Rules of Engagement.
Build strong, trust-based relationships with customers in assigned Immunology accounts.
Manage territory logistics, routing, and account business planning.
Maintain and grow knowledge of national, regional, local, and account market dynamics, including coverage and coding requirements.
Grow knowledge of hub and specialty distribution channels to improve practice and patient support.
Collaborate with internal J&J departments, including marketing, sales, medical science, SCG, IBG, HCC, and PECS.
Serve as a subject matter expert on education and insights related to access and affordability solutions across payer types and plans, including Medicare, Medicaid Managed Care, and commercial plans.
Conduct business in accordance with ethical, legal, and compliance standards, including completing required training on time.
Stay current on and anticipate changes in product coverage, access knowledge, marketplace conditions, and stakeholder practices to deliver approved materials effectively.
Adapt to changes in the healthcare ecosystem to customize resources and messaging for healthcare providers and their staff.

Benefits

Participation in the company’s consolidated retirement plan (pension), subject to plan terms.
401(k) savings plan, subject to plan terms.
Eligibility to participate in the long-term incentive program.
Vacation: 120 hours per calendar year.
Sick time: 40 hours per calendar year, with listed state-specific amounts for Colorado and Washington employees.
Holiday pay, including floating holidays: 13 days per calendar year.
Work, Personal and Family Time: up to 40 hours per calendar year.
Parental Leave: 480 hours within one year of the birth, adoption, or foster care of a child.
Bereavement Leave: 240 hours for an immediate family member and 40 hours for an extended family member per calendar year.
Caregiver Leave: 80 hours in a 52-week rolling period.
Volunteer Leave: 32 hours per calendar year.
Military Spouse Time-Off: 80 hours per calendar year.