Field Reimbursement Manager in Portland, OR

$80K - $100K(Ladders Estimates)

Sun Pharmaceutical Industries   •  

Portland, OR 97201

Industry: Pharmaceuticals & Biotech


5 - 7 years

Posted 39 days ago

Field Reimbursement Manager: The territory will cover the Pacific Northwest region.

The Field Reimbursement Manager is part of the Market Access group supporting Sun's family of branded products in the United States. This primary goal of this role is to support appropriate patient access to care through education of healthcare provider customers as well as internal sales colleagues and managing individual patient cases through to fulfillment of prescription. Educational components include reimbursement (coverage, coding & payment), specialty pharmacy processes, provider support services (e.g., benefits investigation) and patient support resources (e.g., copay assistance programs, patient assistance programs) The person in this role will monitor national and local healthcare payer policies, develop relationships with key advocacy leaders, state societies, and provide direct support to prescribing physicians, hospitals and support staff regarding reimbursement and patient access issues.

Job Scope

The Field Reimbursement Manager will execute local market plans to support field based priorities and manage and triage local health policy, reimbursement, billing / coding, and patient access issues. Field Reimbursement Managers will collaborate with his / her field partners to alleviate reimbursement and access issues impacting physician offices and the ability of patients to access Sun portfolio of products. The Field Reimbursement Manager will interact with access services hub, managed markets team supporting patient access and local field sales teams. The person in this role with have expertise in access and reimbursement issues encompassing coverage, coding and payment guidelines according to payor policy, sites of care, understanding of coding guidelines (CPT/J-Code/ICD-10), statutory or commercial pricing structures or mandates, and quality programs related to value based care and clinical care pathways.

Responsibilities include:

  • Incorporate knowledge of dynamic and complex marketplace and business trends to deliver maximum access to the portfolio of Sun products.
  • Has a deep understanding of medical vs pharmacy benefit and policy
  • Understands the dynamics of Specialty pharmacy and specialty distribution
  • Broad and wide understanding of the physician buy and bill model vs assignment of benefits to alternate sites of care
  • Understands and able to establish alternate sites of care and infusion networks
  • Provide support to local market patient foundations and physician societies for activities related to access.
  • Possess expertise in Medicare policies and the variations within all parts of Medicare
  • Ensure processes are in place to drive clear communication with sales teams to ensure clarity of reimbursement and access issues and opportunities and support pull-through efforts.
  • Listen and respond appropriately to customer needs and questions.
  • Effectively and persuasively communicate with customers using effective selling, listening and negotiation skills, proper terminology and approved messaging.
  • Maintain thorough knowledge of Sun products.
  • Regularly and timely communicate with manager, as well as members of various support teams, as required.
  • Create and maintain a positive impression with customers.
  • Prepare reports for management as needed.
  • Participate in teleconference and live National, regional and district meetings and training sessions and represent Sun at national and/or local conventions when requested.
  • Operate consistent with Healthcare Compliance guidelines.

Job Qualifications

Education: A minimum of a Bachelor's Degree is required.

Experience: 5 or more years of healthcare industry experience required. A minimum of 3 years' experience in the healthcare industry including but not limited to, insurance verification and / or claim adjudication, physician office and outpatient billing, medical benefit procurement and adjudication within Commercial and Government payers…IE All parts of Medicare, Tricare , Medicaid and National and Regional Commercial payers. This position requires up to 80% travel. Experience working in dermatology and/or oncology is preferred.

Additional Requirements

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

• Applies appropriate interpersonal styles and communications methods to influence and build effective relationships with business partners.

• Able to effectively manage competing priorities with strong sense of urgency.

• Able to act as an articulate advocate for the market access team

Valid Through: 2019-11-1