Reimbursement Business Manager-Ophthalmology-Nashville, TN
About The Position
The Reimbursement Business Manager is a critical front-line member of Regeneron’s Ophthalmology Field team. The role uses reimbursement expertise to support internal and external customers and physician offices throughout the reimbursement cycle, helping maintain open communication for existing and future Regeneron products. The position focuses on understanding provider business drivers and developing compliant approaches to account issues and management. This is a remote role located in Nashville, Tennessee, within an assigned territory. The candidate must reside within the territory and be able to travel 50%–70% of the time. The role supports physician offices with reimbursement issues, coverage and coding education, access services, payer requirements and patient access to care.
Requirements
- Bachelor's degree from a four-year college or university.
- 5–8 years of pharmaceutical, biotechnology or medical device experience, including at least 3–5 years of healthcare coverage, coding and/or reimbursement experience.
- Previous experience working with billing and medical claims personnel in healthcare settings, including physician offices, hospitals, HOPDs or ASCs.
- Demonstrated expertise supporting healthcare provider offices with coding, billing and submissions across a range of payer environments.
- Experience implementing and executing Medicare, Medicaid and other payer initiatives.
- Familiarity with CPT, HCPCS, ICD-10, revenue codes, DRG and coverage.
- Familiarity with health insurance claim forms and documents, including UB-04, CMS-1500, explanations of benefits, prior authorization forms and superbills/charge tickets, to troubleshoot billing, claims-submission or documentation errors.
- Ability to analyze, interpret and understand regulatory and legislative payer and healthcare policies.
- Must reside within the assigned territory and be able to travel 50%–70% of the time.
Responsibilities
- Develop and execute account plans that build reimbursement confidence with customers, including physicians and staff, and support continued patient access.
- Educate accounts about support services to ensure patient access to care, and work with leadership to monitor and track the impact of those services and their interactions with providers.
- Develop collaborative relationships with Regeneron colleagues, including Regional Directors and Medical Specialists, to educate physician offices about coverage and coding of Regeneron products and support patient access to care.
- Guide healthcare professionals in resolving reimbursement issues or barriers in accordance with Regeneron policies and processes.
- Anticipate and adapt to customer needs, market changes and challenges.
- Plan and manage time proactively to cover the assigned Field Reimbursement Manager territory efficiently and effectively.
- Establish positive working relationships with accounts, including physicians, administrators and office staff, and effectively manage product concerns.
- Update customers about reimbursement requirements, payer trends and payer policy changes, and use company-approved access materials to support reimbursement confidence.
Benefits
- Annual bonuses or other incentive plans may be included, depending on country and role.
- Equity awards may be included, depending on country and role.
- Pension or retirement benefits may be included, depending on country and role.
- 401(k) company match may be included, depending on country and role.
- Health and wellness programs may be included, depending on country and role.
- Fitness centers may be available, depending on country and role.
- Insurance benefits, including medical, dental, vision, life and disability coverage, may be included, depending on country and role.
- Paid time off may be included, depending on country and role.
- Family support benefits may be included, depending on country and role.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
