Field Reimbursement Manager – Immunology, Dermatology

Role Overview

• Educate HCPs on product coverage, prior authorizations and appeals, reimbursement processes, claims submissions, procedures, and coding requirements of payer organizations (local payers, government payers, etc.) for core and launch products.
• Collaborate with field support team members such as sales representatives and key account managers and serve as reimbursement expert for the local team.
• Act with a sense of urgency to address critical access and affordability issues for patients.
• Partner with managed care colleagues to understand current policies and potential future changes.
• Conduct field-based reimbursement and access support, education and creative problem-solving aligned to FRM Rules of Engagement.
• Build strong, trust-based relationships with customers in all assigned Immunology accounts.
• Manage territory logistics, routing, and account business planning.
• Maintain and grow knowledge of national, regional, local, and account market dynamics including coverage and coding requirements.
• Grow the knowledge of hub and specialty distribution channels to improve practice and patient support needs.
• Collaborate with internal J&J departments such as marketing, sales, medical science, SCG, IBG, HCC, and PECS.
• Serve as subject matter expert regarding education and insights on access and affordability solutions across multiple payer types and plans (i.e., Medicare, Medicaid Managed Care, Commercial).
• Execute business in accordance with the highest ethical, legal, and compliance standards, including timely and successful completion of all required training.
• Remains current on and anticipates changes in product coverage and access knowledge, marketplace conditions, and stakeholder practices to deliver the most effective delivery of approved materials.
• Understands and adapts to the changing healthcare ecosystem to customize resourcing and messaging to HCPs and HCP staff

Requirements

• Bachelor’s degree (preferably in healthcare or business/public administration).
• An advanced business degree (MBA), or public health (MPH) is preferred.
• Minimum of 5 years of relevant professional experience Account Management and/or Reimbursement experience working in the hospital and/or provider office setting, building strong customer relationships.
• Demonstrated expertise with both pharmacy and medical/buy & bill benefits (as applicable), coding, and billing.
• Reimbursement or relevant managed care experience (revenue cycle, buy-and-bill, prior authorization, coding, and appeals processes)
• Ability to establish relationships, collaborate, and influence across a matrix organization.
• Problem-solving ability to navigate challenging access scenarios and identifies solutions in a timely and efficient manner.
• Experience in working with patient support HUB services.
• Valid US driver’s license and a driving record in compliance with company standards
• Ability to consistently maintain up to 50% travel.
• Permanent residence in the listed territory
• Preferred Immunology disease state experience
• Advanced degree and/or relevant certifications in prior authorization and/or billing and coding
• Strong market access acumen as it relates to payer approval processes and business acumen.
• Understanding of Medicare, Medicaid, and private payer initiatives affecting reimbursement of pharmaceutical and biotechnology products.
• Excellent technical knowledge and expertise in payer policy, including all elements of reimbursement (coding, coverage, and payment) is preferred.
• Demonstrated competence with salesforce.com CRM use, Microsoft Word, and Excel

Tech Stack

• SFDC

Benefits

• Subject to the terms of their respective plans, employees are eligible to participate in the Company’s consolidated retirement plan (pension) and savings plan (401(k)).
• This position is eligible to participate in the Company’s long-term incentive program.
• Vacation –120 hours per calendar year
• Sick time
• 40 hours per calendar year; for employees who reside in the State of Colorado –48 hours per calendar year; for employees who reside in the State of Washington –56 hours per calendar year
• Holiday pay, including Floating Holidays –13 days per calendar year
• Work, Personal and Family Time
• up to 40 hours per calendar year
• Parental Leave – 480 hours within one year of the birth/adoption/foster care of a child
• Bereavement Leave – 240 hours for an immediate family member: 40 hours for an extended family member per calendar year
• Caregiver Leave – 80 hours in a 52-week rolling period10 days
• Volunteer Leave – 32 hours per calendar year
• Military Spouse Time-Off – 80 hours per calendar year