Senior Manager, Field Reimbursement - Northwest

Job Summary

Senior Manager, Field Reimbursement (FRM) play a vital role in helping patients gain access to life changing therapies. From oral medications to biosimilars to critical cancer treatments. Fresenius Kabi’s FRMs, with their passion for patients, represent these therapies providing education, coverage, and access solutions to healthcare personnel. Sr. Manager, Field Reimbursement (FRMs) educate and assist office staff on prior authorization requirements, coverage status and payer appeals requirements, processes and timelines. The FRM will assist provider offices in resolving complex coverage and reimbursement issues that may create barriers to access for patients. FRM’s travel weekly, Monday – Thursday, to healthcare offices within a designated geographic territory, using their knowledge of coverage, patient assistance, and health policy to educate office staff and break through access issues to ultimately help patients.
The ideal candidate will live near a major airport in the Northwest part of the United States.
Key States include: Washington and Oregon

Responsibilities

• Develop solutions and plan of action to internal or external reimbursement issues or opportunities. Able to condense complex issues into simple solutions by working with peers and internal stakeholders to improve the customer experience.
• Educating provider offices on local and regional payer issues, coding changes, and appropriate claims submission processes.
• Liaising with reimbursement hotlines regarding alternative funding/financial assistance programs.
• Assisting with determining coverage and access options available for a specific medication or procedure.
• Engage Key Stakeholders at Medicare Advisory Carriers, MAC’s, and Monitor Local Coverage Determinations and articles for assigned MAC’s to ensure coverage is consistent with product label. 
• Work with internal partners to build strategic patient access and reimbursement account plans. Keep abreast of customer and healthcare industry trends. Sees patterns or connections between situations; can envision and articulate possibilities and likelihoods. Initiates development actions to constantly adapt and grow capabilities to increase impact.
• Work with the broad stakeholder team to achieve customer and product strategies and goals.
• Responsible for feeding key customer insights and product trends to HQ personnel, shaping current and future strategies.
• Direct the analysis and measurement of key business drivers and objectives including relationship effectiveness, value proposition and other operational and financial indicators for their customer(s).
• FRM’s will communicate on the following: national commercial payers, PBM’s, Medicaid, Medicare, clinical pathway organizations, payer owned specialty pharmacies, product distribution updates, and state government affairs.
• All employees are responsible for ensuring the compliance to company documents, programs and activities related to Health, Safety, Environment, Energy and Quality Management System as per your roles and responsibilities.

Requirements

• Bachelor’s degree required. Advanced degree preferred.
• 7+ years’ experience with specialty providers in support of reimbursement. Previous experience with both private & public payers is strongly preferred.
• Technical knowledge of health care reimbursement from a patient and provider perspective (authorizations, miscellaneous J codes, billing, coding, prior authorizations, appeals, patient and provider support programs and HUB operations).
• Knowledge of all phases of specialty pharmacy core services and connectivity to assist with the complexity of patient access.
• Knowledge of private payer, Medicare and Medicaid structure systems and reimbursement process.
• Exceptional business and clinical acumen, strong leadership skills and the ability to lead without authority.
• Excellent communication skills, oral and written, Strong presentation skills: ability to clearly convey his/her ideas to key customer stakeholders as well as specific decision makers in selected accounts.
• Strategic thinker: Understands the origin and reasoning behind key policies, practices and procedures and ability to create action plans to resolve issues.
• Ability to interact with senior leaders and work across functional groups to build consensus and action.
• Demonstrated success in account management.
• Ability to work independently without direct supervision.
• Live near a major airport in the designated territory and be able to travel extensively (overnight - 80% of the time) within that territory.

Additional Information

We offer an excellent salary and benefits package including medical, dental and vision coverage, as well as life insurance, disability, 401K with company contribution, and wellness program.

Fresenius Kabi is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, citizenship, immigration status, disabilities, or protected veteran status.