Director, Field Reimbursement (National)

[Position]

Director, Field Reimbursement (National)

[About Our Client]

[Job Summary]

Field Reimbursement Director reports to the VP of Access Operation.

The Field Reimbursement Director will oversee and manage a team of Field Reimbursement Managers (FRM) across assigned territories, ensuring that all aspects of reimbursement strategies are executed effectively to maximize product access and coverage.

The Director will act as a key leader responsible for the coordination of field-based reimbursement efforts, offering strategic direction, support, and leadership to ensure the team is successful in navigating payer landscapes, insurance policies, and reimbursement processes.

[Job Description]

- Leading and managing the FRM team to ensure proper execution of reimbursement strategies, ensuring patient access to products across all geographies.

- Developing and implementing reimbursement strategies to guarantee appropriate coverage and access for company products.

- Working closely with healthcare providers, payers, and patients to ensure the products are covered by insurance plans.

- Reviewing and approving complex reimbursement cases and assisting FRM team members in resolving coverage challenges and issues.

- Monitoring payer policy changes, ensuring alignment with product reimbursement strategies and working with internal teams to address any potential barriers.

- Analyzing payer trends, identifying areas for improvement, and adjusting strategies to ensure the continued success of reimbursement efforts.

- Collaborating with external teams to identify and implement funding or financial assistance programs that support patient access to treatments.

- Supporting the team in handling prior authorizations, appeals, and denials, and ensuring all necessary documentation is submitted in a timely and compliant manner.

- Reviewing patient-specific cases, identifying challenges, and recommending solutions in collaboration with healthcare providers and internal teams.

- Conducting both quantitative and qualitative analysis of FRM team activities and providing detailed reports to VP of Access Operation.

- Based on progress analysis, identifying and implementing improvements to optimize the team's performance and enhance the overall reimbursement process.

Requirements

[Qualifications]

- Bachelor's degree in business, healthcare, or related field.

- Minimum of 10 years of experience in pharmaceutical reimbursement, managed care, or related field, with at least 5 years of experience in a leadership role.

- Immunology and/or Oncology experience a plus

- Strong knowledge of healthcare reimbursement policies and procedures.

- Ability to develop and implement reimbursement strategies.

- Excellent communication and interpersonal skills.

- Strong analytical skills and ability to analyze data and trends.

- Ability to lead and manage a team and work collaboratively with cross-functional stakeholders.

- Ability to work independently and in a team environment.

- Willingness to travel as required.

Benefits

- Salary 200-240k + Bonus

- Full Benefits - Medical, Dental, Vision with different package

- 401k 4.5 % match

- PTO & 6 Sick Days