Title : Field Reimbursement Manager
Reports To : National Director, Field Reimbursement Location : Field-based in the West Region
Classification : Exempt
The Field Reimbursement Manager (FRM) will work as a field-based patient access specialist in an assigned region that provides appropriate reimbursement support to providers and professional staff to help facilitate access to Coherus products.
The FRM will leverage in depth expertise in reimbursement, payer coverage, patient assistance, and healthcare policy to educate offices to help minimize barriers to patient access.
Responsibilities and Duties :
Assist oncology HCPs and staff in resolving reimbursement issues / barriers that complies with Coherus policies, processes and guidelines.
The FRM will serve as a regional reimbursement expert by providing assistance to key oncology offices.
The FRM will work with all engaged sites of care to inform them on matters related to access and reimbursement of Coherus products.
Conduct meetings as needed with key office staff to learn about patient reimbursement challenges and educate them on Coherus reimbursement support for company products.
Extensive knowledge of regional and national payer landscapes with expertise in reimbursement policy, utilization management criteria, prior authorization processes and appeal requirements.
Develop ongoing interaction with clients in a manner that anticipates and adapts to customer reimbursement support needs as well as market changes / challenges.
Demonstrate extensive knowledge of specialty payer landscape, the appropriate utilization of NCCN / ASCO guidelines, private payer, GPOs, Medicare and Medicaid structure, Specialty Pharmacy systems and reimbursement processes and the general evolution of the healthcare landscape.
Work with sales and market access teams within Coherus following national strategy for patient access.
Collaboration with partners as appropriate; Coherus RSDs, Key Account Directors and Oncology Account Managers in assigned region as well as additional Coherus counterparts as defined and the National Account Directors to ensure optimal knowledge of coverage and services for Coherus products within the defined customer base.
FRMs provide strategic coverage / reimbursement leadership and support to Coherus leadership and Field Sales Leadership to which their geographies align.
Educate customers on key billing processes, coverage assistance programs, approved and appropriate coding and access options.
Individual must be able to travel extensively within the region
Excellent interpersonal and communication skills.
Excellent presentation skills
This territory currently covers the following states : CA, WA, OR, HI, AZ, AK, NV, UT
Background and Experience :
Minimum of 10 years’ experience in the pharmaceutical / biotech or related healthcare industry
Minimum 5 years experience with Specialty Pharmaceuticals / Biologics
Strong background in market access and reimbursement
Field reimbursement experience preferred
Experience in the business of oncology related injectables ( Buy and Bill ) is a plus
Ensure strong understanding and utilization of Specialty Pharmacy and third party services.
Must be a true team player and work collaboratively with key internal stakeholders
In depth knowledge of pharmaceutical manufacturer compliance, patient confidentiality, product reimbursement and product access requirements.
Knowledge of regulations and laws governing the protection of patient identifying information, and CMS policies pertaining to access services.
Knowledge of CMS policies and processes with expertise in Part B & D (Medical / Pharmacy Benefit design and coverage policy)
Strong strategic account management planning skills