Institutional Field Reimbursement Manager- NY / Manhattan

EXPERIENCE AND EDUCATIONAL REQUIREMENTS:

Experience directly related and progressively responsible in a medical practice, private or third party reimbursement arena, or pharmaceutical industry in sales, managed care, or clinical support. Experience within healthcare provider support such as a physician practice, patient assistance program or similar pharmaceutical/biological support program experience preferred.

Professional experience:

• Advanced degree preferred.

• Minimum of 8 years of experience.

MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS:

Ability to effectively manage multiple client relationships (e.g., field sales, payer team, support services vendor representatives) and customer

• Proven teamwork and collaboration skills with a demonstrated track record of working in highly matrixed and cross-functional organizations

• Excellent strategic thinking, analytics, and communication skills

• Ability to communicate with and influence key decision makers within sites of care

• Ability to manage multiple tasks, timelines, expenses, and other activities necessary to fulfill the roles and responsibilities of a Field Reimbursement Specialists

• Ability to effectively work with other client's program vendors to deliver a positive customer experience

• Ability to navigate complex healthcare organization structures (e.g., Integrated Health Systems)

• Sound Judgment and decision-making ability with a high degree of emotional intelligence

• Creative problem-solving skills

• Ability to effectively manage competing priorities with a strong sense of urgency

• Demonstrated territory and logistics management skills

• Results oriented

• Excellent communication skills with the ability to present complex information in both informal and formal settings

• Ability to build and maintain effective relationships with business partners and healthcare professionals

• Broad understanding of the physician buy-and-bill model vs. assignment of benefits to alternate sites of care

• Deep understanding of medical and pharmacy benefits/policies

• Understands the dynamics of Specialty Pharmacy vs. Specialty Distribution

• Ensure processes are in place to drive pull through by providing education and resolution on reimbursement and access related issues

• Ability to conduct field-based reimbursement and access support, education, and consultation to key account customers and cross-functional partners

• Experience in revenue cycle, buy and bill (including billing with miscellaneous J-code), formulary, benefit investigations, prior authorization, coding, and appeals processes

• Knowledge of private payer, Medicare, and Medicaid structures, systems, processes, policies, and Utilization Management criteria

• Understanding of, and ability to, educate on pharmaceutical manufacturer patient support programs, including financial and co-payment assistance programs

• Listens and responds appropriately to customer needs and questions

• Strong presentation skills, effective in small group and large groups

• Above average computer skills: MS PowerPoint, MS Excel, MSWord, and MS Outlook

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 require continuous monitoring of compliance with such guidelines and laws.

This position may require credentialing for specific facilities. This process includes passing limited medical examinations and may include some vaccinations and documentation review.

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