Field Reimbursement Manager

Mercalis

3d•Hybrid

About The Position

As a Hybrid Field Reimbursement Manager (HFRM), you will help increase patient access to critical therapies by resolving access challenges, educating healthcare provider (HCP) offices on billing and reimbursement, and supporting sites of care both virtually and directly. You will collaborate with office staff, billing teams, specialty pharmacies, and patient support vendors (HUB, copay card, PAP) to remove access barriers. The HFRM will be HCP-facing and serve as the subject-matter expert on reimbursement, coverage, prior authorizations, and appeals processes.

Requirements

Associate's degree or higher in a related field or equivalent market experience
3+ years in Case Management Reimbursement Experience
3+ in the Pharma/Healthcare industry; working with Hubs, Payers, HCP or related area
Must have specific practice management, billing and/or coding experience for drugs, biologicals, or devices.
Must have general payer policy knowledge including public and private payers, foundational knowledge of medical benefit verifications and prior authorization/pre-determination requirements and knowledge of reimbursement processes within various sites of care.
Demonstrated ability to conduct field-based reimbursement support and education
Experience with new product launches, reimbursement billing, coding, and appeals process.
Knowledge of private payer, Medicare and Medicaid structure, systems, and reimbursement process.
Strong presentation skills
Located in the Southeastern United States
Valid Driver’s License for when travel required

Nice To Haves

Migraine or Neurology background
Experience with closed network, limited distribution SP- PACS certification (if still applicable)
Sales experience is a plus
Strong focus on communication

Responsibilities

Educate accounts and caregivers on enrollment to the specialty pharmacy, program services, payer coverage and benefit design, affordability, billing and coding, prior authorization, appeals support, scheduling and in-home nursing administration and financial assistance programs.
Solve complex patient access issues by working across the Hub, specialty pharmacies, caregiver provider offices and communicating with client field team.
Partner with client’s Sales/Account Management Team, HCPs, and network Specialty Pharmacy to create and drive strategic reimbursement support approaches, resulting in increased access to therapy for individual patients.
Educate HCP and Office Staff on Patient Support Programs, per program specific operating policies and patient journey.
On occasion, lead HCP offices in onsite education of program business rules, payer coverage including review of relevant coding options, including miscellaneous J-codes, at launch as well as other reimbursement related support.
Guide healthcare providers through the prior authorization and appeals process, educating on required documentation, payer-specific requirements, and outcome communication.
The HFRM will manage daily activities that support appropriate patient access to client’s products across relevant sites of care to work as an extension of the support services offered to providers.
Review patient benefit options for an infused therapy including prior authorization requirements, and appeals .
Review appropriate billing and coding for products, assist with resolving reimbursement issues, and help ensure appropriate education to avoid future reimbursement hurdles.
Coordinate with client’s patient support services programs representatives on patient cases and claim issues.
Educate office staff on the use of client’s patient assistance and reimbursement support services, including but not limited to web-based provider programs and tools, and provide information on relevant reimbursement topics related to client’s products.
Conduct policy surveillance across regional payers to ensure appropriate coding, coverage, and payment of client’s products.
Assist providers with understanding local payer coverage and reimbursement trends through educational breakfast, lunch, and dinner programs.
Communicate reimbursement concerns and issues with appropriate internal stakeholders, including Sales and Managed Markets.
Understand and monitor national and regional payer trends and changes.
Work collaboratively with Managed Markets team to escalate potential payer issues.
Operate in Compliance with HIPAA within program guidelines.
On time adherence to training deadlines for all corporate policies and procedures governing access to confidential data
Ensure all SOPs and BRDs are followed with consistency
Conducts miscellaneous tasks or projects as assigned