Job Description

Field Reimbursement Manager

Mercalis is an integrated life sciences commercialization partner that provides comprehensive solutions that span the entire healthcare value chain. Backed by proven industry expertise and results-driven technology, Mercalis helps navigate the complex life sciences marketplace by providing commercialization solutions to accelerate value and enhance patient lives.

Mercalis 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 solutions that eliminate barriers 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 help eliminate barriers 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 on appropriate billing and coding for clients products, and provide educational services within relevant sites of care. Additionally, the FRM role will work directly with office support staff, billing and coding staff, third party vendors (HUB, Copay Card, Patient Assistance Program (PAP)), and other important stakeholders involved with supporting patient access to our clients therapies. The FRM will operate as the subject-matter expert on medical benefit reimbursement, access, and coverage issues including Prior Authorization and Appeals.

Responsibilities

• Solve complex patient access issues by working across the Hub, provider offices and communicating with client field team.
• Partner with clients Sales Team Reginal Account Managers (RAMs), Marketing, HCPs, and their Specialty Pharmacyies to 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 coverage including review of miscellaneous J-codes, and other reimbursement related activities.
• Guide healthcare providers through the prior authorization and appeals process, assisting with required documentation, payer-specific requirements, and outcome communication.
• The FRM will manage daily activities that support appropriate patient access to clients products across relevant sites of care to work as an extension of the HUB reimbursement support services offered to providers.
• Review patient medical benefit options, prior authorization requirements, and appeals and alternate funding/financial assistance programs.
• Review appropriate billing and coding for products, assist with resolving reimbursement issues, and help ensure appropriate education to avoid future reimbursement hurdles.
• Coordinate with clients patient support services programs representatives on patient cases and claim issues.
• Educate office staff on the use of clients patient assistance and reimbursement support services, including but not limited to web-based provider programs and tools, and provide information on relevant reimbursement topics related to clients products.
• Conduct policy surveillance across regional payers to ensure appropriate coding, coverage, and payment of clients products.
• Assist providers with understanding local payer coverage and reimbursement trends through educational breakfast, lunch, and dinner programs.
• Lead sales training related to product reimbursement, as appropriate.
• Communicate reimbursement concerns and issues with appropriate internal stakeholders, including Sales and Managed Markets.
• Understand and monitor national and regional payer trends and changes.
• Work collaboratively with Managed Markets 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 SOPs and BRDs are followed with consistency.
• Conducts miscellaneous tasks or projects as assigned.

Qualifications

• Associates degree or higher in a related field or equivalent market experience.
• 3+ years in Case Management Reimbursement Experience.
• 3+ in the Pharma/Healthcare industry; working with Hubs, Payers, HCP or related area.
• 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 of medical benefit verifications and prior authorization/pre-determination requirements and knowledge of reimbursement processes within various sites of care.
• Demonstrated ability to conduct field-based reimbursement support and education.
• Experience with new product launches, reimbursement billing, coding, and appeals process.
• Knowledge of private payer, Medicare and Medicaid structure, systems, and reimbursement process.
• Strong presentation skills.
• Travel Requirements:
• Job may require up to 20% travel.
• Additional travel will be required for various national meetings, training programs and POAs.
• Valid Drivers License for those wherewhen travel required.

Why work for Mercalis?

• Our Mission is rewarding and fulfilling (Patient Access to Life-Saving/Improving/Extending Medications/Treatments).
• We employ the best Talent and Tools from the Patient Access Industry (We are the Industry Leader).
• We monitor the market to ensure we offer competitive salaries and benefits.
• 401K w/ 5% matching; day-1 vestment period.
• 15 days PTO.
• 8 Holidays + 2 Floating Days.
• Health/Dental/Vision/Life; Coverage Day-1.
• Gym Reimbursement.
• Volunteer Hours.

About Us Mercalis is an integrated life sciences commercialization partner providing comprehensive solutions across the healthcare value chain. Backed by deep industry expertise and results-driven technology, we accelerate value for clients and improve patients lives by eliminating access barriers and expanding availability of life-changing therapies.

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