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Field Reimbursement Manager, Delaware Valley

4 months ago

King of Prussia, United States CSL Full time
This position is US Field-Based / Selected Candidate must reside within one hour of a major airport within region of responsibility (Delaware Valley Region of US- DC, DE, MD, NJ, PA)

The Manager of Reimbursement will be responsible for managing the day-to-day tactical field based reimbursement activities in their geography including but not limited to conducting field reimbursement in-services and educational workshops for Patient Advocacy groups, Health Care Professional (HCP) offices, Specialty Pharmacies and distributors for all therapies. Works with payer and channel Customer Account Managers in educating and resolving reimbursement issues with all accounts. Works with field sales organization and third party patient access programs to resolve reimbursement issues and improve patient access to therapies. Works directly with consumer groups for reimbursement education and training, and manages relationships with regional Medicare offices and Carrier Advisory Committees.

Main Responsibilities and Accountabilities:
  • Work with payers, specialty pharmacies, physician champions, and professional societies to secure adequate reimbursement of CSL Behring therapies
  • Aid physicians, sites of service and their support staff in the reimbursement process. Provide in-service training to sales and marketing on the fundamentals of healthcare economics.
  • Execute reimbursement strategies that proactively integrate and align with marketing and sales strategies.
  • Execute strategies with third party payers to insure adequate reimbursement (hospitals, home health providers, ambulatory care centers and physicians)
  • Work directly with third party payers and Medicare offices to insure adequate reimbursement for our products.
  • Provide monthly report recounting significant activities, progress and follow-up needed.
  • Assess reimbursement environment (coverage, coding and payment) for any new products and procedures.
  • Work with payer and channel Customer Account Managers in educating and resolving reimbursement issues with SP (Specialty Pharmacy) accounts, and attend customer account calls with payer and channel CAMs as needed to present reimbursement information on CSL therapies and answer any questions the accounts may have.
  • Work with field sales organization and third party patient access programs via patient access hotline (HUB) to resolve reimbursement issues and improve patient access to therapies.
  • Perform field reimbursement in-services such as account visits, presentations to healthcare providers and other medical staff. Conduct billing procedure review for home care companies, pharmacies, and other providers experiencing inadequate reimbursement across the portfolio.
  • Work directly with consumer groups to supply reimbursement education and training. This should be accomplished by attending and conducting patient education workshops at regional and national consumer group meetings (IDF, JMF, HAEA, NHF, etc.).
  • Work with consumer groups to coordinate the use of CSL Behring Assurance and Assistance programs. Return patient and family calls regarding insurance and appeals, and assist in a positive outcome.
  • Collaborate with the Patient Services team to ensure the Hub offerings are up to date with the changing reimbursement landscape, including HUB training and managing challenging cases.
  • Attend trade shows (AAAAI, HAEA, NHF, NHIA AMCP, CMSA, etc.), and be able to present reimbursement information as requested by the various groups.
  • Work with the Director of Reimbursement in developing and executing on tactical programs for strategic accounts.

Bachelor's degree required

3- 5 years' experience in healthcare industry. Prior reimbursement or case management experience required. Prior work with patient advocacy group desirable. Excellent verbal and written communication skills. Demonstrated ability to work both independently and in group settings.

Requires 50-60% domestic travel

Different qualifications or responsibilities may apply based on local legal and/or educational requirements. Refer to local job documentation where applicable

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Our Benefits

CSL employees that work at least 30 hours per week are eligible for benefits effective day 1. We are committed to the wellbeing of our employees and their loved ones. CSL offers resources and benefits, from health care to financial protection, so you can focus on doing work that matters. Our benefits are designed to support the needs of our employees at every stage of their life. Whether you are considering starting a family, need help paying for emergency back up care or summer camp, looking for mental health resources, planning for your financial future, or supporting your favorite charity with a matching contribution, CSL has many benefits to help achieve your goals.

Please take the time to review our benefits site to see what's available to you as a CSL employee.
About CSL Behring

CSL Behring is a global leader in developing and delivering high-quality medicines that treat people with rare and serious diseases. Our treatments offer promise for people in more than 100 countries living with conditions in the immunology, hematology, cardiovascular and metabolic, respiratory, and transplant therapeutic areas. Learn more about CSL Behring.

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As a global organization with employees in 35+ countries, CSL embraces diversity and inclusion. Learn more about Diversity & Inclusion at CSL.

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