• Field Reimbursement Manager

    Job Locations US-Field
    Job ID 2018-1040
  • Overview

    The Field Reimbursement Manager (FRM) is a regionally aligned, field-based position that provides reimbursement education and support for customers that purchase ophthalmic products from EyePoint Pharmaceuticals. Customers may include hospitals/hospital outpatient departments, physician practices, and other appropriate site-of-care facilities as well as specialty pharmacies. The FRM will work closely with HCPs, pharmacists, billing and coding staff and other professionals involved in securing appropriate reimbursement for the use of EyePoint products.

    Responsibilities

     

    The FRM provides support through (1) product-specific provider reimbursement support, (2) coordination of HUB reimbursement services, and (3) managing payer/coverage pull-through initiatives.  The FRM must have a solid working knowledge of buy-and-bill reimbursement, as well as a clear understanding of Medicare, Medicare Advantage, Commercial, and Medicaid insurance plans and benefit design.

     

    The FRM is expected to be a subject matter expert on reimbursement processes (i.e., benefit verification, prior authorization, claim assistance, and appeals) and knowledgeable of current eyecare market dynamics. In addition, the FRM needs to build and maintain strong relationships with health care provider practices and facilities, while implementing and managing field reimbursement responsibilities. The FRM role includes a great deal of travel, and requires a high degree of communication, account coordination and cross-functional collaboration.

    Essential responsibilities of the FRM include:

    • Proactively educate prescriber office personnel so that they may help patients gain access to our products through effective utilization of EyePoint patient services. Educate on coding of EyePoint products (CPT, ICD9-ICD10, HCPCS), including payer specific instructions on reimbursement/billing for new drugs/biologics described by a miscellaneous J code, using PRC approved materials.
    • Reactively address access and reimbursement issues arising from these customers; and provide necessary education for them to secure appropriate reimbursement and access
    • Provide PRC approved information related to product coverage, which may include payer specific requirements for claims processing, information regarding prior authorizations and the appeals process, as well as general information regarding disease state.
    • Interact with healthcare professionals, as well as patients if necessary, to understand access and reimbursement issues and work toward resolution. Maintain communication with sales personnel throughout interactions and follow through to resolution.
    • Interact with Market Access Regional Account Directors, as needed, for issue resolution
    • Provide healthcare professionals with PRC approved support materials and sample forms and letters to assist in obtaining reimbursement of EyePoint products. This includes, for example, a sample CMS 1500 Billing Form template.
    • Coordinate with field sales regarding prioritization of accounts to ensure timely access to EyePoint products. Ensure ongoing communication with field sales regarding account follow-up plan.
    • Serve as a primary point of contact for Market Access team for distribution and payer issues.
    • Serve as an escalation point for the hub to educate customers on appropriate available patient support programs. Explain the copay assistance and other funding options available to patients for EyePoint products. Provide PRC approved materials describing such programs and refer to the applicable EyePoint website(s) describing such programs. Help the practice understand how to enroll patients in the appropriate program. Advocate for EyePoint hub service utilization for patient-specific access support needs.

    Internal and External Contacts:

    The FRM must work effectively with multiple key EyePoint stakeholders in a matrix environment to achieve target objectives and meet established KPIs.

    Internal:  Market Access, Field Sales, Marketing, other Patient Services teams (including outsourced hub services), and MSL (as needed)

    External: HCPs, pharmacy, and billing/coding staff associated with key customers, as well as patients being treated in these institutions

    • Academic centers, community hospital, ASCs
    • Consortium members, and buy and bill MD offices
    • Specialty Pharmacies
    • Medicare Administrative Contractors

    Qualifications

    Education and Experience Requirements:

    • Education:  BA/BS degree required.
    • Minimum 3- 5 years of prior field-based reimbursement and access experience required
    • Minimum of 3 years of other related pharmaceutical experience strongly preferred (e.g., Market Access, Sales, Product Marketing)

    Key Skills, Abilities and Competencies:

    • Demonstrated high performance in a reimbursement/access support role
    • Experience in a field-based customer support role
    • Expert-level understanding of local, regional and national commercial and public insurance markets
    • Strong understanding of specialty pharmacy operations and specialty product distribution channels
    • Ability to work cross-functionally and succeed in a team environment while also demonstrating a high-level of personal accountability
    • Proven track record for bringing a high degree of insight, creativity, and listening to patient and provider needs to develop and deliver patient services in a high impact, innovative and cost-effective way
    • Strong interpersonal and communication skills

    Complexity and Problem Solving:

    • Knowledge of relevant medical and pharmaceutical payer coverage policies. Ability to continually monitor policies and effectively communicate changes
    • Ability to proactively plan and closely coordinate account interactions in conjunction with other field-based teams
    • Ability to balance proactive education and reactive problem solving to address critical customer issues that arise

    Other Job Requirements:

    Position requires extensive domestic travel (up to 80%)

    Regional Alignment:

    • East Region: North East, Mid-Atlantic, Washington D.C. Metro Area, Great Lakes
    • Central Region: North Central South East, Florida
    • West Region: Northwest, Southwest, South Central

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