Title: Field Reimbursement Manager-Maryland/DC/VA-Market Access
The Field Reimbursement Manager is part of the Market Access group supporting Sun’s family of branded products in the United States. This primary goal of this role is to support appropriate patient access to care. This team focuses their efforts on supporting practices, accounts, and providers with necessary support materials and education to seek coverage to therapy for appropriate patients. Educational components include reimbursement (coverage, coding & payment), specialty pharmacy and distribution processes, provider support services (e.g., benefits investigation) and patient support resources (e.g., copay assistance programs, patient assistance programs) The person in this role will monitor national and local healthcare payer policies, develop relationships with key advocacy leaders, state societies, and provide direct support to prescribing physicians, hospitals and support staff regarding reimbursement and product access and reimbursement dynamic within payer channels.
The Field Reimbursement Manager will execute local market plans to support field based priorities. This will include understanding and educating on local health policy, reimbursement, billing / coding, and patient access issues. Field Reimbursement Managers will collaborate with his / her field partners to alleviate reimbursement and access issues impacting physician offices and the ability of patients to access Sun portfolio of products. The Field Reimbursement Manager will interact with access services hub, managed markets team supporting patient access and local field sales teams. The person in this role with have expertise in access and reimbursement issues encompassing coverage, prior authorizations, appeals, exceptions, denials, coding and payer payment guidelines , payer policies, sites of care, understanding of coding guidelines (CPT/J-Code/ICD-10), statutory or commercial pricing structures or mandates, and quality programs related to value based care and clinical care pathways.
Responsibilities include:
• Incorporate knowledge of dynamic and complex marketplace and business trends to deliver maximum access to the portfolio of Sun products.
• Has a deep understanding of medical vs pharmacy benefit and policy
• Understands the dynamics of Specialty pharmacy and specialty distribution
• Demonstrates a broad and wide understanding of the physician buy and bill model vs assignment of benefits to alternate sites of care
• Understands and is able to establish alternate sites of care to support patient options.
• Possess expertise in Medicare policies and the variations within all parts of Medicare
• Ensure processes are in place to drive clear communication with sales teams to ensure clarity of reimbursement and access issues and opportunities and support pull-through efforts.
• Listen and respond appropriately to customer needs and questions.
• Effectively and persuasively communicate with customers using effective selling, listening and negotiation skills, proper terminology and approved messaging.
• Maintain thorough knowledge of Sun products.
• Regularly and timely communicate with manager, as well as members of various support teams, as required.
• Create and maintain a positive impression with customers.
• Prepare reports for management as needed.
• Participate in teleconference and live National, regional and district meetings and training sessions and represent Sun at national and/or local conventions when requested.
• Ensure behaviors consistent with Healthcare Compliance guidelines.
Job Qualifications:
Education: A minimum of a Bachelor’s Degree is required.
Experience: 8 or more years of healthcare industry experience required. A minimum of 5 years’ experience in the healthcare industry including a strong understanding of but not limited to, insurance verification and / or claim adjudication, physician office and outpatient billing, medical benefit procurement, understanding of adjudication within Commercial and Government payers, buy and bill model, Medicare, Tricare , Medicaid and National and Regional Commercial payers. Experience working in Dermatology and/or Oncology is a plus.
Additional Requirements
• Proven teamwork and collaboration skills with a demonstrated track record of working in highly matrixed and cross-functional work teams
• Applies appropriate interpersonal styles and communications methods to influence and build effective relationships with business partners.
• Able to effectively manage competing priorities with strong sense of urgency.
• Able to act as an articulate advocate for the market access team
• Provides consistent communications (both positive and negative information delivery) and is proactive and time in the conveyance of this information.
• Uses appropriate methods and interpersonal styles to develop, motivate, and guide a team toward successful outcomes and attainment of business objectives.
• Strong written and verbal communication skills.
• Strong presentation skills.
• Highly developed analytical skills with demonstrated ability to conceptualize issues and synthesize data to provide strategic direction
• Experience in Sun Pharma’s therapeutic areas: Dermatology, Oncology, Biologics preferred
• Acts as a role model for others in line with Sun’s values
- Candidate must live within geographical area
- Required 3 day minimum in the field conducting live call on target accounts