Access Reimbursement Manager
- Field, BC, Canada
Full-time
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Job details
- Job type
- Full-time
- Apply by
- Posting language
- English
- Posted
Original job description
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
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.
- 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
More about this job
Responsibilities
Manage a territory-based access and reimbursement program, educating healthcare providers and office staff on coverage, authorization, reimbursement processes, and patient support services. Resolve patient-level reimbursement issues compliantly, coordinate with internal and external partners, and communicate payer changes to relevant stakeholders.
Requirements
Requires at least 3 years of experience in managed care, field reimbursement, patient services, specialty or biologic sales, or healthcare practice management, along with a bachelor’s degree or 8+ years in related roles. Candidates should have specialty-product and complex reimbursement experience, strong communication and analytical skills, Medicare knowledge, a valid driver’s license, and the ability to travel 3–4 days per week.
Skills
- Field Reimbursement
- Market Access
- Patient Services
- Payer Expertise
- Insurance Authorization
- Prior Authorization
- Appeals
- Claims Resolution
- Healthcare Provider Education
- Patient Support Programs
- Medicare Policies
- Medical Insurance Terminology
- Analytical Skills
- Problem Solving
Visa sponsorship
Not detected in the job text
Categories
- Healthcare
- Management & Leadership
- Customer Service & Support
- Consulting
- Sales
Keywords
- Market Access
- Field Reimbursement
- Patient Services
- Managed Care
- Specialty Products
- Biologic Products
- Complex Reimbursement
- Patient Support Programs
- Healthcare Provider Education
- Payer Changes
- Formulary Coverage
- Utilization Management
- Benefits Investigation
- Prior Authorization
- Appeals
- Claims Resolution
- Medicare Part B
- Medicare Part D
- Centers for Medicare & Medicaid Services
- Patient Health Information
- Provider Portals
- Specialty Pharmacy Services
- Copay Assistance
- Patient Assistance
- Bridge Programs
- Expense Reports
- Territory Management
- Rules of Engagement