Access & Reimbursement Manager
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Job Description
Virtual Access & Reimbursement Manager supporting U.S. cardiovascular pharmaceutical patient access. Educating provider offices on payer requirements, reimbursement, prior authorizations, and patient support services.
Responsibilities:
- Serve as a dedicated virtual access and reimbursement resource supporting evolving coverage needs across client-defined geographies
- Rapidly assess new geographic landscapes, establish productive virtual relationships, and transition between territories while maintaining continuity of support and service
- Educate provider offices on payer requirements, reimbursement processes, patient support services, and approved access resources
- Provide education to healthcare providers and office staff regarding access services and reimbursement solutions for cardiovascular products and therapeutic areas
- Develop and execute territory access plans and prioritize accounts based on client-defined objectives
- Coordinate compliantly with sales, market access, patient services, hub/specialty pharmacy partners, and other matrix stakeholders
- Document activities in the approved CRM platform
- Support patient-level access and reimbursement issue resolution as permitted by program design and Rules of Engagement
- Manage daily virtual activities via phone, Zoom, Webex, Teams, and similar platforms
- Support field vacancies, white space, and overflow case management virtually
- Assume responsibility for new territory assignments while maintaining consistent program execution and customer support
- Provide education on Retail and Specialty Pharmacy prior authorizations, appeals, and denials
- Participate in client, internal team, and cross-functional meetings and calls
- Monitor payer policy, formulary coverage, utilization management requirements, pharmacy access pathways, prior authorization trends, denial patterns, and other access barriers
- Communicate relevant payer and field insights to internal stakeholders
- Provide office education on formulary coverage, utilization management criteria, coding, insurance forms and procedures, benefits investigation, prior authorization, appeals, and claims resolution
- Use only client-approved materials, messaging, processes, and resources
- Identify and communicate field access insights, payer trends, office workflow barriers, and reimbursement challenges
- Recognize and report adverse events, product complaints, and other reportable information in accordance with client policy and applicable requirements
Requirements:
- 3+ years of experience in Managed Care, Field Reimbursement, Patient Services, Sales (Specialty or Biologics), or healthcare provider office practice management
- 4-year degree in a related field or equivalent experience
- Ability to quickly integrate into new business environments, adapt to changing coverage needs and territory priorities, and maintain consistent customer support and program execution
- Cardiovascular/Cardiology and Hospital Healthcare Systems experience a plus
- Experience and understanding of Retail Pharmacies and Specialty Pharmacies
- Ability to educate offices on access processes and issue resolution
- Experience educating HCPs and office staff on client-specific Patient Service programs, such as copay programs
- Experience delivering educational presentations in person or via Zoom, Webex, and/or Teams
- Advanced knowledge of medical insurance terminology
- Knowledge of Centers for Medicare & Medicaid Services (CMS) policies and processes, with expertise in Medicare Part D for Pharmacy Benefit products
- Ability to develop and maintain trusted relationships with internal partners and work effectively in teams
- Ability to manage ambiguity and solve problems
- Ability to prepare and submit expense reports in a timely fashion
- Valid driver's license
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