Sr. Manager, Field Reimbursement
- Partner with the commercial team and 3rd party support teams to remove barriers to patient access.
- Educate the Sales team and healthcare providers and office staff on benefit verification, prior authorizations, patient cost-share, and drug acquisition options.
- Lead scheduled calls, webinars, and virtual office hours on payer policies, common denial trends, and reimbursement best practices.
- Act as the primary reimbursement resource for field reps, supporting them with proactive strategies to drive utilization and payer confidence.
- Collaborate with Market Access leadership to develop standardized tools (coding guides, payer updates, talking points).
- Guide coding, payer policies, claim approvals, and appeals for denied or underpaid claims.
- Monitor reimbursement trends and payer policy changes, escalating issues that may affect patient access.
- Lead business and claims reviews in collaboration with leadership.
- Maintain knowledge of and build relationships with regional and national payer landscapes, utilization management, and prior authorization processes.
- Communicate policy updates clearly to customers and internal stakeholders.
- Uphold compliance with regulatory and ethical standards related to patient assistance programs.
- Bachelor’s degree in a related field. Master’s preferred
- Minimum of 5 years of experience in market access, specialty pharmaceuticals or surgical devices in a professional capacity.
- At least 3 years of direct experience in reimbursement, payer policy, or healthcare policy is preferred.
- Experience in eyecare or ophthalmology is advantageous.
- Demonstrated expertise in physician-administered injectables and/or medical devices, including working with Category III CPT codes, miscellaneous J-codes, specialty pharmacy, buy-and-bill processes, benefit verification, prior authorizations, claims management, and appeals.
- Experience navigating coverage and reimbursement with Medicare, Medicare Advantage, commercial, and Medicaid plans.
- Strong understanding of healthcare provider reimbursement challenges and practice economics.
- Willingness and ability to travel as needed to support territory coverage, including overnight travel (~60%), and participation in required trainings and meetings.
- Demonstrated leadership and project management skills.
- Experience educating Healthcare Professionals on the availability of patient support programs such as Co-Pay Assistance and Patient Assistance Programs.
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