Field Reimbursement Manager (North East)

Territory: Albany/Saratoga NY, CT

Position Summary: 

The Field Reimbursement Manager (FRM) helps minimize access & reimbursement barriers for patients and providers to optimize access to Apellis’ 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 Apellis reimbursement support programs for retina practices, multi-specialty groups, 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 Apellis products within practices and sites of care where applicable.  Additionally, the FRM will analyze reimbursement and access issues and, in conjunction with their manager, act as the local access and reimbursement resource for internal Apellis 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; Implement updates/changes based on solutions generated to address issues.
• Identify facilities and practices that need reimbursement education and support regarding Apellis products.  
• Provide insights and updates regarding product and support service integration at accounts.
• Educate facility staff on policies related to product acquisition, inventory management, product returns and replacement to support full integration of product into practice workflow.
• Provide coverage, coding and reimbursement information to key staff members (i.e., practice manager, nursing, billing, and reimbursement staff) 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 in assigned accounts.
• Proactively communicate Apellis specific patient services programs, policies, procedures and resource so that office staff is fluent in how to use access programs and systems.
• Support questions associated with patient coverage, access, and reimbursement from accounts in collaboration and coordination with patient services as directed by policy and procedure.
• Conduct quarterly reviews with practices on their utilization of Apellis reimbursement support services to better understand how we may evolve our offering to best suit the needs of the customer.
• Maintain a deep understanding of Apellis policies and requirements and perform all responsibilities in a manner consistent with company guidance. 
• Handle PHI appropriately.
• Maintain compliant relationships with relevant state, local, institutional or other societies. 
• Keep abreast of customer and market access industry trends. 

Experience:

• 10 years of commercial experience in the pharmaceutical or biotech industry.
• 5+ years of experience in healthcare coverage, coding and/or reimbursement experience.
• Experience with Buy and Bill products, Medicare Part B and Miscellaneous J-Codes required.
• Ophthalmology experience strongly preferred.
• Start-up experience 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, and 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 have the ability to travel 50-70%.

Benefits and Perks:

Apellis