Field Reimbursement Manager Market Access - Central Region

ADMA Biologics is a biopharmaceutical company committed to creating products for immunodeficient patients at risk for infection. The Field Reimbursement Manager will support providers and field teams across the Central Region by providing education on reimbursement, payer coverage, policies, prior authorizations, appeals, and patient support programs. The role will also serve as a regional market access expert, lead training, collaborate cross-functionally, and maintain compliance with applicable policies and regulations.

Responsibilities:

• Provide clear and detailed coverage, criteria and policy education to healthcare provider offices, physician owned infusion suites, ambulatory infusion suites, National and Regional Specialty pharmacies/Home Infusion providers and hospital-based outpatient infusion centers
• The (FRM) will work with the ADvantage Ig Patient Support Program (HUB) to help ensure clear and transparent communication between providers and ADMA
• Communicate technical knowledge of patient enrollment, prior authorizations, appeals, and ADMA Biologics sponsored HUB support programs
• Serve as the market access training lead for respective territory, delivering policy updates and program information as needed
• Collaborate in cross-functional meetings with Sales, Market access, and Medical Affairs as needed to help support providers
• Maintain compliance with PHI/HIPAA and company policies
• This role will cover the Central region and will be responsible for the central United States, as well as covering additional regions as needed
• This is a remote role and travel within your region and national meeting will be approximately (65-75%)
• The FRM will support healthcare providers and ADMA field teams across the following regions:
• Great Lakes: Ohio, Michigan, and Western Pennsylvania, including Pittsburgh
• Upper Midwest: Illinois, Wisconsin, and Indiana
• Great Plains: Kansas, Missouri, Nebraska, Iowa, Oklahoma, Minnesota, and Arkansas
• Employees are responsible for ensuring compliance with all ADMA Quality policies, standards, and SOPs in their area of work and responsibility. This includes ensuring all Quality Assurance (QA) records and reports, Human Resources (HR) policies, and Environmental Health and Safety (EH&S) procedures and practices are completed in a timely manner
• Maintain compliance with PHI/HIPAA and company policies

Requirements:

• • 10 years of experience working for a major pharmaceutical organization on the field reimbursement team, understanding different site of care provider segments and payors, i.e., (Commercial, Medicare, Medicaid, VA/DOD/Tricare, and ACA) as well as a deep understanding of the Medical and Pharmacy benefits, billing and coding practices for infused products is required
• • Extensive frontline experience working with and across the various infusion service areas within the US health care system. Specifically, Physician Buy and Bill offices, Ambulatory Infusion suites, National and Regional Specialty Pharmacies/Home Infusion Providers and hospital owned outpatient infusion centers
• • Must be able to understand and clearly disseminate payor policy and criteria for coverage in the medical and pharmacy benefit to existing and future providers
• • Must be able to think independently, analyze issues and make recommendations that will help providers and patients obtain coverage to start therapy
• • Must have extensive Buy and Bill experience in Rare Disease, Plasma/IVIG, Oncology or Orphan Disease
• • Strong understanding of healthcare regulatory and enforcement environments along with demonstrated integrity on the job
• • Employees are responsible for ensuring compliance with all ADMA Quality policies, standards, and SOPs in their area of work and responsibility. This includes ensuring all Quality Assurance (QA) records and reports, Human Resources (HR) policies, and Environmental Health and Safety (EH&S) procedures and practices are completed in a timely manner
• • Must be Proficient in Microsoft Office, Excel, and PowerPoint and Teams
• • Strong people skills
• • Excellent written and verbal communication skills
• • BA/BS/RN degree required, preferably in life science, business, or nursing, master's degree a plus
• RN is highly desirable