Field Reimbursement Specialist

4 weeks ago


San Francisco, California, United States Coherus BioSciences Full time
Job Summary

The Field Reimbursement Manager at Coherus BioSciences plays a vital role in ensuring patients and providers have seamless access to our Oncology product portfolio. This position requires a strong understanding of the pharmaceutical industry, healthcare coverage, coding, and reimbursement processes. The ideal candidate will have 5+ years of commercial experience in the pharmaceutical or biotech industry, with a focus on healthcare coverage, coding, and/or reimbursement. Additionally, they should have a deep understanding of Coherus policies and requirements, as well as the ability to analyze and interpret regulatory and legislative payer and healthcare policies.

Key Responsibilities

* Partner with internal and external stakeholders to identify, anticipate, and address patient and practice reimbursement issues
* Collaborate with Field Sales to identify facilities and practices that need reimbursement education and support regarding Coherus products
* Provide insights and updates regarding product and support service integration at accounts
* Educate facility staff on policies related to product acquisition, inventory management, and all payer policies related to support full integration of product into the practice workflow
* Provide coverage, coding, and reimbursement information to key staff members (i.e., practice administrators, reimbursement staff, and providers) 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
* Proactively communicate Coherus COMPLETETM so that office staff is fluent in how to use patient access programs and services
* Address questions associated with patient coverage, access, and reimbursement from accounts in collaboration and coordination with patient services as directed by policy and procedure
* Conduct frequent claim reviews with practices to ensure appropriate reimbursement of Coherus products

Requirements

* 5+ years of commercial experience in the pharmaceutical or biotech industry
* ~3+ years of experience in healthcare coverage, coding, and/or reimbursement
* ~ Bachelor's degree from a four-year college or university
* Previous experience working with billing and medical claims personnel in various healthcare settings, including physician office, hospital, HOPD, and ASC
* Shown expertise in supporting healthcare provider offices with coding, billing, and submissions in range of payer environments
* Familiarity with health insurance claim forms, explanation of benefits, prior authorization forms, and EMR/Practice Mgmt. systems, 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
* Travel Requirements: Candidate must reside within assigned territory and have the ability to travel up to 70%

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