Field Reimbursement Specialist
4 days ago
Job Summary:
The Field Reimbursement Manager will be responsible for managing the day-to-day tactical field-based reimbursement activities in their geography. This includes conducting field reimbursement in-services and educational workshops for Patient Advocacy groups, Health Care Professional (HCP) offices, Specialty Pharmacies, and distributors for all CSL therapies.
Works with payer and channel Customer Account Managers in educating and resolving reimbursement issues with all accounts. Collaborates 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, physicians, physician support staff, 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 objectives.
- Work directly with third-party payers and Medicare offices to ensure 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.
Key Responsibilities:
- 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.).
- 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 Sr. Director of Reimbursement in developing and executing on tactical programs for strategic accounts.
Position Qualifications and Experience Requirements:
- Bachelor's degree required (business /management, healthcare discipline or life sciences preferred)
- 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
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