Field Reimbursement Manager
3 weeks ago
The Field Reimbursement Manager plays a crucial role in minimizing access and reimbursement barriers for patients and providers to optimize access to Apellis' Ophthalmology portfolio. This position requires a strong understanding of the pharmaceutical industry, reimbursement processes, and access solutions.
Key Responsibilities:
Partner with internal and external stakeholders to identify, anticipate, and address patient and practice reimbursement issues.
Implement updates and 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 to appropriately support patient access.
Collaborate with field-facing teams 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.
Requirements:
Bachelor's degree from a four-year college or university.
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.
Preferred Skills:
Previous experience working with billing and medical claims personnel in various healthcare settings, including physician offices, hospitals, HOPDs, and ASCs.
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%.
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