Title: Field Reimbursement Manager, Retina
Reports To: Sr. National Director, Field Reimbursement
Location: Field-based in the West Region
The Field Reimbursement Manager (FRM) helps minimize access & reimbursement barriers for patients and providers to optimize access to Coherus' Ophthalmology portfolio. Within their geography, the FRM is responsible for addressing access barriers by strategically working with customers and accounts to solve the most complex patient access issues through all facets of the reimbursement cycle. The FRM proactively provides education and support on Coherus reimbursement support programs (Coherus COMPLETE ™ ) to retina practices, facilities, and their staff.
As a member of the front-line field team, they serve as the key contact responsible for reimbursement and access support-related matter. The FRM will provide education and support the integration of account implementation plans for Coherus products within practices and sites of care where applicable. Additionally, the FRM will analyze reimbursement and access issues and act as the local access and reimbursement resource for internal Coherus partners in their assigned geography. The FRM will coordinate cross functionally across Corporate Accounts, Patient Services and Field Sales to support patient drug accessibility.
Key responsibilities include:
- Partner with internal and external stakeholders to identify, anticipate and address patient and practice reimbursement issues
- Collaborate with Field Sales to identify facilities and practices that need reimbursement education and support regarding Coherus products.
- Provide insights and updates regarding product and support service integration at accounts.
- Educate facility staff on policies related to product acquisition, inventory management, and all payer polices related to support full integration of product into the practice workflow.
- Provide coverage, coding, and reimbursement information to key staff members (i.e., practice administrators, reimbursement staff, and providers) in order to appropriately support patient access.
- Collaborate with field facing "One Team" to compliantly share insights into customer needs, potential barriers, and payer issues/opportunities for access at practices.
- Communicate and explain payer policy updates or system changes that impact access.
- Proactively communicate Coherus COMPLETE ™ so that office staff is fluent in how to use patient access programs and services.
- Address questions associated with patient coverage, access, and reimbursement from accounts in collaboration and coordination with patient services as directed by policy and procedure.
- Conduct frequent claim reviews with practices to ensure appropriate reimbursement of Coherus products.
- Maintain a deep understanding of Coherus policies and requirements and perform the role in a compliant manner consistent with company guidance.
- Keep abreast of customer and market access industry trends.
- 5+ years of commercial experience in the pharmaceutical or biotech industry.
- 3+ years of experience in healthcare coverage, coding and/or reimbursement.
- Experience with Buy and Bill products, Medicare Part B and Miscellaneous J-Codes required.
- Retina experience strongly preferred.
- Bachelor's degree from a four-year college or university.
Skills, Knowledge & Abilities:
- Previous experience working with billing and medical claims personnel in various health care settings, including physician office, hospital, HOPD and ASC.
- Shown expertise in supporting healthcare provider offices with coding, billing, and submissions in range of payer environments.
- Well versed with implementing and executing Medicare, Medicaid, and other payer initiatives.
- Familiar with CPT, HCPCS, ICD-10 revenue codes.
- Familiarity with health insurance claim forms including UB-04, CMS-1450, CMS-1500, explanation of benefits, prior authorization forms, and super bills charge tickets to troubleshoot cases where billing, claims submission or documentation errors may occur.
- Ability to analyze, interpret and understand regulatory and legislative payer and healthcare policies.
- Candidate must reside within assigned territory and have the ability to travel up to 70%.
Beginning July 19, 2021, Coherus BioSciences requires all new hires to be fully vaccinated against COVID-19 as of their start date. This requirement is a condition of employment at Coherus BioSciences, and it applies regardless of whether the position is located at a Coherus BioSciences facility or is fully remote. If you are unable to receive the vaccine due to a disability or serious medical condition, or because it is prohibited as a result of your sincerely held religious beliefs, you will have an opportunity to request a reasonable accommodation.