Field Reimbursement Manager

Title:                            Field Reimbursement Manager
Reports To:                 Sr. National Director, Field Reimbursement
Location:                     Field-based in the Southeast Region (FL,GA,AL,TN)
Classification:             Exempt
 

Position Summary: 

The Field Reimbursement Manager (FRM) helps minimize access & reimbursement barriers for patients and providers to optimize access to Coherus' complete product 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 Coherus reimbursement support programs (Coherus COMPLETE) to practices, 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 matter.  The FRM will provide education and support the integration of account implementation plans for Coherus products within practices and sites of care where applicable.  Additionally, the FRM will analyze reimbursement and access issues and act as the local access and reimbursement resource for internal Coherus partners in their assigned geography. The FRM will coordinate cross functionally across Corporate Accounts, Patient Services and Field Sales to support patient drug accessibility.

 Key responsibilities include:

• 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 polices 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 COMPLETE 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.
• Maintain a deep understanding of Coherus policies and requirements and perform the role in a compliant manner consistent with company guidance. 
• Keep abreast of customer and market access industry trends. 

Experience:

• 5+ years of commercial experience in the pharmaceutical or biotech industry.
• 3+ years of experience in healthcare coverage, coding and/or reimbursement.
• Direct eExperience with Buy and Bill products, Medicare Part B and Miscellaneous J-Codes required.
• Retina and/or Oncology experience strongly preferred.
• Bachelor's degree from a four-year college or university.

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 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, explanation of benefits, prior authorization forms, and EMR 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%.