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Field Reimbursement Manager

Syneos Health/ inVentiv Health Commercial LLC
medical insurance, paid time off, sick time, 401(k)
United States, Georgia, Atlanta
Feb 06, 2025
Description Introduction/Background : The Field Reimbursement Manager will be responsible for the management of defined accounts in a specified geographic region in the Non-Opioid Pain Therapeutic area. The Reimbursement Manager will execute the collaborative territory strategic plan through partnership with internal and external stakeholders, including call center services and collaboration partners. Responsibilities include ensuring optimal Reimbursement and creating understanding of Reimbursement services and program support as it relates to the non-opioid pain product portfolio. Note this is not a sales job. The Field Reimbursement Manager will be supporting a specialty buy and bill administered therapy. Services and Activities Provided by Reimbursement Managers Field reimbursement manager manage daily activities that support appropriate patient reimbursement to our client's products in the provider offices and work as a liaison to other patient assistance and Reimbursement support services offered by our clients. Activities include, but are not limited to: Act as an extension of Exparel; provide live one-on-one coverage support. Offer assistance from physician order to reimbursement, supporting the entire Reimbursement journey through payer prior authorization to appeals/denials requirements procedures and forms Reviewing patient-specific information in cases where the site has specifically requested the assistance in resolving any issues or coverage challenges. Reviewing patient insurance benefit options Identifying alternate funding/financial assistance programs Coordinating with our client's patient support services programs representatives. Educating physician office staff on the use of our client's patient assistance and call center support services, including web-based provider programs Provide information on relevant Reimbursement topics related to our client's products. Serve as payer expert for defined geography and able to communicate changes to key stakeholders in a timely manner Provide office support in accurate coding and billing for Pacira products Skills Required To Be A Successful Reimbursement Manager Three skills critical to being successful in this position include: General payer policy knowledge including managed care and Medicare/Medicaid Foundational knowledge of benefit verifications and prior authorization requirements Knowledge of Reimbursement and billing processes within the physician office Ability to review clinical information in patient charts, understand and interpret payer policy to provide guidance to HCP offices on how they may proceed in filling out prior authorization/formulary exception/appeals documentation Specific knowledge of specialty product buy and bill, coding, and in office best practices on program management Specific knowledge of local payer policies related to a specific client product will be acquired during training sessions. All interactions with allied health professionals require detailed attention to customer needs and satisfaction. And most importantly, all Reimbursement activities are required to be conducted and managed within all appropriate legal and regulatory guidelines and our client's compliance policies and require continuous monitoring of compliance with such guidelines and laws. Minimum Qualifications & Education : Bachelor's degree required 7+ years' experience in a pharmaceutical commercial environment Demonstrated experience in a pharmaceutical field market access, trade, reimbursement services or related role; or 3+ years of experience in a sales or sales leadership role Experience in public or private third-party access arena or pharmaceutical industry focused on field reimbursement, managed care, and/or billing and coding support working with a Buy and Bill product. A thorough understanding of the entire reimbursement process from script to injection Physician Buy and Bill in a Medicare environment experience required Experience with coding, billing and in office support of these programs Establishing relationships within a practice by working closely with them to help remove Reimbursement barriers to specialty products for their patients Ability to operate as a "team player" in collaborating with multiple sales representatives, sales leadership, and internal colleagues to reach common goals Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare Part D (Pharmacy Benefit design and coverage policy) a plus Knowledge of Managed Care, Government, and Federal payer sectors, as well as Integrated Delivery Network/Integrated Health Systems a plus Previous experience in launching new specialty pharmaceutical/biologics products or indications a plus Ability to travel and cover large multistate geography territories, 50% travel required Excellent presentation skills Advanced knowledge of medical insurance terminology Strong teamwork abilities Project management skills Ability to work independently Ability to manage expenses within allocated budgets Good driving record Ability to schedule individual work-related travel (air, hotel, rental car as needed) Above average computer skills: PowerPoint, Excel, Word, CRM (Salesforce.com) At Syneos Health, we are dedicated to building a diverse, inclusive and authentic workplace. If your past experience doesn't align perfectly, we encourage you to apply anyway. At times, we will consider transferable skills from previous roles. We also encourage you to join our Talent Network to stay connected to additional career opportunities. Why Syneos Health? Our ability to collaborate and problem-solve makes a difference in patients' lives daily. By joining one of our field access teams, you will partner with industry experts and be empowered to succeed with the support, resources, and autonomy needed to successfully navigate the complex reimbursement landscape. The diversification and breadth of our new and existing partnerships create a multitude of career paths and employment opportunities. Join our game-changing, global company dedicated to creating better, smarter, faster ways to get biopharmaceutical therapies to patients Experience the thrill of knowing that your everyday efforts are contributing to improving patients' lives around the world. Work Here Matters Everywhere \| How are you inspired to change lives? Syneos Health companies are affirmative action/equal opportunity employers (Minorities/Females/Veterans/Disabled) Syneos Health has a voluntary COVID-19 vaccination policy. We strongly encourage all employees to be fully vaccinated. Additionally, certain local governments or Syneos Health customers may have vaccine requirements that apply to some of our employees. These employees are required to submit proof of vaccination to Syneos Health and maintain compliance with these requirements. At Syneos Health, we believe in providing an environment and culture in which Our People can thrive, develop and advance. We reward and recognize our people by providing valuable benefits and a quality-of-life balance. The benefits for this position will include a competitive compensation package, Health benefits to include Medical, Dental and Vision, Company match 401k, flexible paid time off (PTO) and sick time. Because certain states and municipalities have regulated paid sick time requirements, eligibility for paid sick time may vary depending on where you work. Syneos Health complies with all applicable federal, state, and municipal paid sick time requirements.