Job Title: Field Reimbursement Manager – Hemophilia
Duration: 1 Year (possible extension)
Location:

• Field Based, East
• Field Based, West

Physical Requirements: Ability to travel up to 75% 

 

Job Summary: We are seeking experienced and passionate Field Reimbursement Managers to join our team, specializing in hemophilia. This role will focus on ensuring access to our hemophilia therapies, educating healthcare professionals about reimbursement processes, and collaborating with internal teams to support our commitment to improving patient outcomes.

Key Responsibilities:

• Serve as a primary point of contact for healthcare providers and internal stakeholders regarding reimbursement-related inquiries for hemophilia therapies.
• Collaborate with provider offices and specialty pharmacies, and provider offices to facilitate reimbursement and establish productive working relationships.
• Monitor reimbursement trends and changes in healthcare policies that may impact access to hemophilia treatments, advising the organization as needed.
• Assist in building, tracking, and reporting on key performance indicators to monitor overall performance.
• Work closely with the pharmacy to review benefits investigation and provide prior authorization and appeals support, as requested.
• Ensure compliance with reimbursement regulations and guidelines.
• Develop and maintain relationships with billing and coding staff, and develop a deep understanding of their business including patient demographics, payer landscape, regional payers, networks/affiliations, etc.
• Use approved tools, such as dashboards and coding guides to assist offices with a smooth and efficient patient journey towards therapy access.
• Gather and analyze data on reimbursement challenges and address them proactively through collaboration with cross-functional teams.
• Manage their own budget.
• Successfully manage other projects as directed with proven results.

Access Education

• Educate healthcare professionals and patient support teams about existing reimbursement processes, policies, and available financial assistance programs.
• Assist HCPs in understanding patients’ insurance benefits, navigating financial assistance options, and overcoming access barriers.
• Provide training and resources to internal sales and marketing teams about reimbursement processes related to hemophilia therapies.
• Deliver approved leave-behind product educational materials to help inform relevant office personnel of reimbursement landscape/policies/criteria.

Communicate and Collaborate      

• Collaborate with other field reimbursement managers to identify the best practices seen in different practice settings across the country.
• Quickly identify, communicate, and address outstanding reimbursement issues and trends, escalating to FRM leadership, Sales, Market Access, Marketing and others to help inform additional support and resource needs.
• Proactively communicate with the Market Access account team to gain a complete understanding of payer-specific coverage, medical and pharmacy policies, and utilization management criteria (i.e. Step Therapy, PA, etc.).
• Regularly interact with field matrix teams to identify, assess and address issues in assigned geography.
• Inform and support internal teams on the development of reimbursement related resources and tools for use by customers.

Required Qualifications:

• Bachelor’s degree required, preferably in a science or business discipline.
• 4+ years of relevant pharmaceutical sales or reimbursement experience with at least 2+ years field reimbursement (pharmacy and buy-n-bill) experience.
• Comprehensive knowledge and understanding of payer billing practices in the US health care system, including Medicare, Commercial, Medicaid and other payer archetypes.
• Strong understanding of drug reimbursement processes and insurance policies.
• Experience in the manufacturing sector, particularly in understanding the supply chain and distribution processes for pharmaceutical products.
• Preferred experience in implementing patient access initiatives (i.e. hub programs).
• Preferred knowledge of hemophilia treatment landscape and related regulatory guidelines.

Skills Necessary for Success:

• Excellent communication and interpersonal skills to build relationships with healthcare providers and internal teams.
• Technical knowledge of health care reimbursement from a patient and provider perspective (authorizations, miscellaneous J codes, billing, coding, prior authorizations, appeals, patient and provider support programs and HUB operations).
• Strong analytical and problem-solving skills to proactively identify and resolve reimbursement issues.
• Firm understanding of HIPAA rules and regulations related to patient privacy.
• Ability to work independently and collaboratively within a fast-paced team environment.
• Proficient in utilizing reimbursement software tools and CRM systems to track interactions and outcomes.
• High level of empathy and commitment to patient advocacy.

 

About Us: SPECTRAFORCE is one of the fastest-growing workforce solutions firms in the United States. As a diversity-owned business, we place human connection at the heart of everything we do, building strong relationships with both clients and candidates to fill roles successfully. Our teams in North and Central America and India serve more than 150 Fortune clients globally, leveraging custom AI technology to provide direct hire, executive search, nearshoring, offshoring, and project staffing solutions.
 
Benefits: SPECTRAFORCE offers ACA compliant health benefits as well as dental, vision, accident, critical illness, voluntary life, and hospital indemnity insurances to eligible employees. Additional benefits offered to eligible employees include commuter benefits, 401K plan with matching, and a referral bonus program. SPECTRAFORCE provides unpaid leave as well as paid sick leave when required by law.

Equal Opportunity Employer: SPECTRAFORCE is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, religion, color, sex, national origin, age, sexual orientation, gender identity, genetic information, disability or veteran status, or any other category protected by applicable federal, state, or local laws. Please contact Human Resources at LOA@spectraforce.com if you require reasonable accommodation.
 
California Applicant Notice: SPECTRAFORCE is committed to complying with the California Privacy Rights Act (“CPRA”) effective January 1, 2023; and all data privacy laws in the jurisdictions in which it recruits and hires employees. A Notice to California Job Applicants Regarding the Collection of Personal Information can be located on our website. Applicants with disabilities may access this notice in an alternative format by contacting NAHR@spectraforce.com.
 
LA County, CA Applicant Notice: If you are selected for this position with SPECTRAFORCE, your offer is contingent upon the satisfactory completion of several requirements, including but not limited to, a criminal background check. We consider qualified applicants with arrest or conviction records for employment in accordance with all local ordinances and state laws, including the Los Angeles County Fair Chance Ordinance for Employers (FCO) and the California Fair Chance Act (FCA). The background check assessment will consider whether a criminal history could reasonably have a direct, adverse impact on the job-related safety, security, trust, regulatory compliance, or suitability for this role. Such findings may result in withdrawal of a conditional job offer. 


At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $60.00/hr.