Overview
Valeris is an integrated life sciences commercialization partner that provides comprehensive solutions that span the entire healthcare value chain. Backed by proven industryexpertiseand results-driven technology, Valeris helps navigate the complex life sciences marketplace by providing commercialization solutions to accelerate value and enhance patient lives.
Valeris fosters a culture that encourages individuality and provides opportunities for creativity, growth, and success while fostering a team environment. We are a diversity-driven organization with an inclusive approach to delivering patient-centric solutionsthat eliminatebarriers for patients, and increase patient access to life altering medications.
As a Field Reimbursement Manager (FRM), you will join our team on a journey to helpeliminatebarriers for patients to help increase their access to medications while working in an environment of collaboration. You will help resolve patient access issues, educate healthcare provider offices onappropriate billingand coding forclient’sproducts, and provide educational services within relevant sites of care. Additionally, the FRM role will work directly with office support staff,billingand coding staff, applicable third party vendors(HUB, Copay Card, Patient Assistance Program (PAP)),and other important stakeholders involved with supportingpatientaccess to our client’s therapies. The FRM willoperateas the subject-matterexpert onmedicalbenefitreimbursement,access,andcoverage issuesincluding PriorAuthorizationandAppeals.
Responsibilities
Responsibilities
- Solvecomplex patient access issues by working across the Hub, provider offices and communicating withclientfield team.
- Partner withclient’sSalesTeam, Payer Teams,Marketing,HCPs,andtheirSpecialty Pharmaciesto create and drive strategic reimbursement support approaches, resulting in increased access to therapy for individual patients.
- Educate HCP and Office Staff on Patient Support Programs, per program specific operating policies and patient journey.
- On occasion, lead HCP offices in onsite education of program business rules, payer coverageincluding review of miscellaneous J-codes, and other reimbursement related activities.
- Guide healthcare providers through the prior authorization and appeals process,assistingwith required documentation, payer-specific requirements, and outcome communication.
- The FRM will manage daily activities that supportappropriate patientaccess to client’s products across relevant sites of care to work as an extension of the HUB reimbursement support services offered to providers.
- Reviewappropriate billingand coding for products,assistwith resolving reimbursement issues, and help ensureappropriate educationto avoid future reimbursement hurdles.
- Coordinate with client’s patient support services programs representatives on patient cases and claim issues.
- Educate office staff on the use of client’s patientassistanceand reimbursement support services, including but not limited to web-based provider programs and tools, and provide information on relevant reimbursement topics related to client’s products.
- Conduct policy surveillance across regional payers to ensureappropriate coding, coverage, and payment ofclient’sproducts.
- Assistproviders with understanding local payer coverage and reimbursement trends through educational breakfast, lunch, and dinner programs.
- Lead sales training related to product reimbursement, asappropriate.
- Communicate reimbursement concerns and issues withappropriate internalstakeholders, including Sales and Managed Markets.
- Understand andmonitornational and regional payer trends and changes.
- Work collaboratively withManagedMarkets team to escalate potential payer issues.
- Operate in Compliance with HIPAA within program guidelines.
- On time adherence to training deadlines for all corporate policies and procedures governing access to confidential data
- Ensure all SOPsand BRDsarefollowed with consistency
Qualifications
Qualifications
- Associate's degree or higher in a related field or equivalent market experience
- 3+ in Pharma/Healthcare industry; working with specialty products, Hubs, Payers,HCPor related area
- Preferred: direct experience with specialty dermatology products
- Must have specific practice management, billing and/or coding experience for drugs, biologicals, or devices.
- Must have general payer policy knowledge including public and private payers, foundational knowledge ofmedicalbenefit verifications and prior authorization/pre-determination requirements and knowledge of reimbursement processes within various sites of care.
- Demonstrated ability to conduct virtual and field-based reimbursement support and education
- Experience with Prior Authorizations, reimbursement billing, coding, and appeals process.
- Knowledge of commercialpayer, Medicare and Medicaid structure, systems, and reimbursementprocess.
- Strong stakeholder engagement and communication skills
- Job mayrequireup to10% travel
- Additionaltravel will berequiredforvarious national meetings, training programsand POAs
- Valid Driver’s License for whentravelis required
