Description

Role Overview

The Field Reimbursement Manager is a field-based member of the Medexus Market Access team responsible for building reimbursement confidence at the point of care for hospital products. The role supports hospitals, health systems, academic medical centers, transplant centers, by providing compliant education and practical guidance on coverage, coding, billing, prior authorization, claims, denials, appeals, and site-of-care reimbursement considerations. Success in this role requires direct experience with hospital reimbursement and revenue cycle workflows across both inpatient and outpatient sites of care, including familiarity with UB-04 and CMS-1500 claims pathways, charge capture, charge description master coordination, inpatient prospective payment considerations such as NTAP, hospital outpatient billing, payer policy requirements, and patient access support processes. The role partners closely with Regional Account Directors, National Account Directors, Transplant Engagement Managers, Medical Affairs, HUB / Core Connections, Legal, Compliance, Commercial, and other cross-functional teams to identify and resolve access barriers that may delay appropriate patient starts or sustained utilization.

Key Responsibilities

• Provide compliant education to hospitals, health systems, academic medical centers, transplant centers, and other institutional customers regarding reimbursement, patient access, coding, billing, and approved support resources.
• Support provider teams in navigating coverage, prior authorization, reimbursement, and operational access processes to improve patient access and treatment continuity.
• Educate key stakeholders, including revenue cycle, billing, coding, patient access, pharmacy, finance, and clinical support teams, on approved reimbursement resources and processes.
• Facilitate customer understanding of reimbursement workflows and operational considerations without guaranteeing coverage, coding, or payment outcomes.
• Assist customers in addressing reimbursement, claims, prior authorization, denial, and appeals challenges using approved resources and established escalation pathways.
• Partner with HUB and patient support teams to coordinate access support and ensure appropriate handoffs throughout the patient journey.
• Identify recurring reimbursement and access barriers and communicate trends and insights to internal stakeholders.
• Escalate complex reimbursement issues to the appropriate internal functions, including Market Access, Patient Services,
• Legal, Compliance, Medical Affairs, and Payer Account Management.
• Partner with Regional Account Directors, National Account Directors, Transplant
• Engagement Managers, and other field teams to support account readiness, formulary pull-through, reimbursement education, and institutional adoption.
• Participate in account planning, customer engagements, and cross-functional discussions to proactively identify and address access barriers.
• Support implementation of reimbursement and patient access strategies that align with broader commercial and market access objectives.
• Maintain accurate and timely documentation of customer interactions, reimbursement barriers, action plans, and follow-up activities in company systems.
• Monitor reimbursement trends, payer policy changes, and customer challenges to provide actionable field insights.
• Contribute to the development and refinement of reimbursement resources, educational materials, and market access strategies.
• Maintain current knowledge of reimbursement, patient access, and healthcare policy developments relevant to Medexus products.

Qualifications & Experience

• Bachelor's degree required; advanced reimbursement, coding, healthcare administration, nursing, pharmacy, business, or related credentials preferred.
• 5+ years of field reimbursement experience within the pharmaceutical, biotechnology, or healthcare industry including direct experience supporting hospital reimbursement, institutional billing, revenue cycle operations, patient access, and provider reimbursement workflows.
• Experience working with hospitals, health systems, academic medical centers, transplant centers, integrated delivery networks, or other complex healthcare organizations.
• Experience supporting hospital product launches, formulary adoption, account readiness, or market access initiatives.
• Strong knowledge of U.S. healthcare coverage, coding, reimbursement, payer policy, benefit investigation, prior authorization, claims adjudication, denials, appeals, and reimbursement support processes, including inpatient and outpatient reimbursement models.
• Experience educating healthcare providers and institutional stakeholders on reimbursement, access, and patient support programs.
• Experience supporting specialty pharmaceutical products, including hospital-administered, infused, injectable, biologic, oncology, hematology, transplant, rare disease, or other specialty therapies.
• Demonstrated ability to identify reimbursement barriers, develop solutions, and navigate complex patient access challenges.
• Experience utilizing CRM, HUB, reimbursement, claims, or patient access data to identify trends and improve customer support.
• Relevant certifications such as CPC, CCS, CRCR, CMRS, or other reimbursement, coding, or revenue cycle credentials preferred.

Additional Information

• Location: Remote position located in the US
• Travel: approximately 20% travel
• Compensation: $165,000-$210,000

We recognize that experience comes in many forms. Even if your background or compensation expectations don't exactly align with all the qualifications or compensation range listed, we encourage you to apply. Your unique skills and experience may be a great fit for this role or other opportunities at Medexus.

Compensation

$165,000.00 - $210,000.00 per year