Access Reimbursement Manager

Job summary

Manage a territory to support patient and provider access to products by educating healthcare offices on coverage, reimbursement processes, and patient support services. Resolve patient-level reimbursement issues, coordinate with internal and external partners, communicate payer changes, and document field activity in the customer CRM while following compliance requirements.

Job details

About Stratis Group: Stratis Group is an independent pharmaceutical consulting firm that specializes in commercialization throughout a brand’s lifecycle, our core passions include: market access, patient services, field reimbursement, and data-driven analytics. Summary In this contracted role, the Access Reimbursement Manager (ARM) is a client-facing and client-customer facing role that will be responsible for managing a dedicated territory to support access for provider and patients. This role will be highly visible within the organization and responsible for providing education to healthcare providers and office staff on access services and reimbursement solutions specific to a product and therapeutic area. The ARM will execute a region or territory strategic plan through partnership with internal and external stakeholders, which may include call center services (HUB), sales, market access, and/or other matrix field partners. Responsibilities include ensuring understanding of the reimbursement process, field reimbursement services, and client’s patient support program. The ARM will also work on patient-level reimbursement issue resolution, and thus will need access to and have had experience with patient health information (PHI). The ARM will abide in a compliant manner and will work closely within a defined set Rules of Engagement. In this role, the ARM will demonstrate a compliant and consultative approach to help offices obtain insurance authorization and/or reimbursement of products for appropriate patients. The ARM will have a direct impact on providing a positive experience for both the HCP Customer and Patient. Additional Responsibilities Include Manage daily activities that support appropriate patient access to our client’s products in the provider offices and work as a liaison to other patient assistance and access support services offered by our clients (i.e. HUB, Call Center, Specialty Pharmacy Services). Act as an extension of client’s HUB, as appropriate and provide in-person customer visits. Participate in client meetings as appropriate. Participate in regularly scheduled team meetings and calls. Input call activity into customer CRM, as appropriate. Serve as payer expert for defined geography and able to communicate payer changes to key stakeholders in a timely manner. Provide office education and awareness during the entire access process which may include formulary coverage/utilization management criteria, insurance forms & procedures, benefits investigation, prior authorization, appeal, and/or claims resolution. Educate offices using approved educational materials provided by the client. Review specific patient case information, in a compliant manner, defined by the client. Educate physician office staff on the use of our client’s patient support services, including web-based provider portals. Desired Job Requirements 3+ years of experience in one or more of the following areas: Managed Care, Field Reimbursement, Patient Services and/or Sales (Specialty or Biologics) or healthcare provider practice management 4 year degree or 8+ years in related healthcare roles and/or pharmaceutical or medical industry Ability to travel 3-4 days a week, with overnights and flights (as needed), must reside within the territory Solution oriented mindset, strong business acumen, & strong analytic capabilities Experience with specialty/biologic products and/or complex reimbursement process Demonstrated ability to educate offices on access processes and issue resolution Experience educating HCPs on client specific Patient Service programs (i.e. copay, nurse education, bridge, patient assistance, etc.) Experience delivering educational presentations in person and/or via technology platforms such as Zoom, Webex, and/or Teams Advanced knowledge of medical insurance terminology Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare (Part B – for buy & bill products and Part D for Pharmacy products) Ability to manage ambiguity & problem solve Prepare and submit appropriate expense reports in a timely fashion Valid Driver’s License

What you’ll do

Manage a territory to support patient and provider access to products by educating healthcare offices on coverage, reimbursement processes, and patient support services. Resolve patient-level reimbursement issues, coordinate with internal and external partners, communicate payer changes, and document field activity in the customer CRM while following compliance requirements.

Requirements

Candidates need at least 3 years of experience in managed care, field reimbursement, patient services, specialty or biologics sales, or healthcare practice management, along with a four-year degree or 8+ years in related roles. The role also requires reimbursement and insurance expertise, strong communication and problem-solving abilities, a valid driver’s license, and availability for travel 3–4 days per week.

Listed skills

• Problem solving · Preferred

Other relevant skills

Identified from the job description. Confirm important requirements above.

• Field Reimbursement
• Market Access
• Patient Services
• Healthcare Provider Education
• Reimbursement Issue Resolution
• Insurance Authorization
• Prior Authorization
• Appeals
• Payer Knowledge
• Medicare Policies
• Patient Support Programs
• Specialty and Biologic Products
• Stakeholder Collaboration
• Analytical Skills
• Problem Solving
• Customer Relationship Management

Job areas

• Healthcare
• Customer Service & Support
• Consulting
• Management & Leadership
• Sales

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