Field Reimbursement Manager
2 days ago
Position Summary:
The Field Reimbursement Manager (FRM) helps minimize access & reimbursement barriers for patients and providers to optimize access to Apellis' Ophthalmology portfolio. Within their geography, the FRM is responsible for addressing access barriers by strategically working with customers and accounts to solve the most complex patient access issues through all facets of the reimbursement cycle. The FRM proactively provides education and support on Apellis reimbursement support programs for retina practices, multi-specialty groups, facilities and their staff.
As a member of the front-line field team, they serve as the key contact responsible for reimbursement and access support-related matters. The FRM will provide education and support the integration of account implementation plans for Apellis products within practices and sites of care where applicable. Additionally, the FRM will analyze reimbursement and access issues and, in conjunction with their manager, act as the local access and reimbursement resource for internal Apellis partners in their assigned geography. The FRM will coordinate cross functionally across Corporate Accounts, Patient Services and Field Sales to support patient drug accessibility.
Territory: Orange County/LA
Key Responsibilities Include:
- Partner with internal and external stakeholders to identify, anticipate and address patient and practice reimbursement issues; implement updates/changes based on solutions generated to address issues.
- Identify facilities and practices that need reimbursement education and support regarding Apellis products.
- Provide insights and updates regarding product and support service integration at accounts.
- Educate facility staff on policies related to product acquisition, inventory management, product returns and replacement to support full integration of product into practice workflow.
- Provide coverage, coding and reimbursement information to key staff members (i.e., practice manager, nursing, billing, and reimbursement staff) in order to appropriately support patient access.
- Collaborate with field facing "One Team" to compliantly share insights into customer needs, potential barriers and payer issues/opportunities for access at practices.
- Communicate and explain payer policy updates or system changes that impact access in assigned accounts.
- Proactively communicate Apellis specific patient services programs, policies, procedures and resources so that office staff is fluent in how to use access programs and systems.
- Support questions associated with patient coverage, access, and reimbursement from accounts in collaboration and coordination with patient services as directed by policy and procedure.
- Conduct quarterly reviews with practices on their utilization of Apellis reimbursement support services to better understand how we may evolve our offering to best suit the needs of the customer.
- Maintain a deep understanding of Apellis policies and requirements and perform all responsibilities in a manner consistent with company guidance.
- Handle PHI appropriately.
- Maintain compliant relationships with relevant state, local, institutional or other societies.
- Keep abreast of customer and market access industry trends.
Education, Registration & Certification:
- Bachelor's degree from a four-year college or university.
Experience:
- 10 years of commercial experience in the pharmaceutical or biotech industry.
- 5+ years of experience in healthcare coverage, coding and/or reimbursement experience.
- Experience with Buy and Bill products, Medicare Part B and Miscellaneous J-Codes required.
- Ophthalmology experience strongly preferred.
- Start-up experience preferred.
Skills, Knowledge & Abilities:
- Previous experience working with billing and medical claims personnel in various health care settings, including physician office, hospital, HOPD and ASC.
- Shown expertise in supporting healthcare provider offices with coding, billing, and submissions in a range of payer environments.
- Well versed with implementing and executing Medicare, Medicaid, and other payer initiatives.
- Familiar with CPT, HCPCS, ICD-10 revenue codes.
- Familiarity with health insurance claim forms including UB-04, CMS-1450, CMS-1500, explanation of benefits, and prior authorization forms, and super bills charge tickets to troubleshoot cases where billing, claims submission or documentation errors may occur.
- Ability to analyze, interpret and understand regulatory and legislative payer and healthcare policies.
- Candidate must have the ability to travel 50-70%.
Benefits and Perks:
Apellis offers a great benefit package which includes: health insurance with full premium coverage , 401K with company match, paid time off (PTO), long-term disability insurance, life insurance and more Visit to learn more.
Company Background:
Apellis Pharmaceuticals, Inc. is a global biopharmaceutical company that combines courageous science and compassion to develop life-changing therapies for some of the most challenging diseases patients face. We ushered in the first new class of complement medicine in 15 years and now have two approved medicines targeting C3. These include the first and only therapy for geographic atrophy, a leading cause of blindness around the world. With nearly a dozen clinical and pre-clinical programs underway, we believe we have only begun to unlock the potential of targeting C3 across many serious diseases.
For more information, please visit or follow us on Twitter and LinkedIn.
EEO Statement:
Apellis is an equal opportunity employer and complies with all applicable federal, state and local fair employment practices laws. Apellis strictly prohibits and does not tolerate discrimination against employees, applicants or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including pregnancy), gender (including gender nonconformity and status as a transgender or transsexual individual), age, physical or mental disability, citizenship, past, current or prospective service in the uniformed services, genetic information, marital status, AIDS/HIV status, smoker/nonsmoker, and occupational pneumoconiosis or any other characteristic protected under applicable federal, state or local law.
For San Francisco postings: Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
Other Duties:
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
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