Job Description Summary

The Field Reimbursement Manager (FRM) is a customer-facing access & reimbursement subject matter expert who provides education, support center integration and patient level issue resolution across the Pharmaceutical Diagnostic (PDx) portfolio. Customers range from Prescribers to Radiologists and Nuclear Medics and their associated office staff. The FRM will create value through education, procedural efficiency through in supporting the determination of benefits and reimbursement and embedding GEHC’s world class support center within customers’ practices and/or health systems. The FRM will collaborate with cross functional partners to deliver expertise, knowledge, and solutions. The ideal candidate will need to be self-directed and proficient at identifying reimbursement issues, providing customer solutions. Experience in creating supporting reimbursement documentation like Reimbursement Guides, checklists, etc. is also required.

The PDx business is the number one global supplier of contrast media and molecular imaging agents used to enhance medical imaging exams for major disease area diagnostic and treatment pathways. PDx products support three patients every second around the world.

This position is field-based and will cover the New England region with travel up to 50% required. The preferred candidate will be local to the Boston area. This position will report to the Sr Director of Patient Services.

Job Description

Roles and Responsibilities

· Will be subject matter expert on all reimbursement support programs, payer claim processes, and access issue resolution.

· Develop & perform On-boarding & In-service presentations (in-person and virtual) with new and existing customer accounts.

· Responsible for proactive customer (prescribers, office staff, imagers, etc.) education about the PDx portfolio’s Payer Coverage policies, reimbursement processes, patient services, and benefit investigation.

· Primary point of contact responsible for resolving general and patient specific access and reimbursement challenges by leveraging the required internal and external resources.

· Develop Access & Reimbursement tools and Guides and disseminate approved content related to product coverage, claims processing, prior authorizations, and appeals.

· Maintain ongoing communication with the Market Access Account Executives and Sales to provide field intelligence and prioritize key accounts regarding account interactions.

· Attend conferences to promote GEHC’s Patient Support Services.

Required Qualifications

· Bachelor’s degree or equivalent

· Minimum of 5 years’ experience in the US healthcare medical device, or pharmaceutical sector.

· Minimum of 3 years’ US FRM experience

· Knowledge of and experience with medical benefit reimbursement and payment mechanisms including medical coding, claims and billing processes.

· Comprehensive knowledge of Government (Medicare/Medicaid, etc.) & Commercial coverage/ reimbursement dynamics.

· Familiarity with provider office and hospital outpatient department reimbursement, regulations, customers, and account-based planning.

· Knowledge of the radiology authorization process including but not limited to understanding HCPCS, CPT, and ICD-10 codes and associated regulations.

· Experience working with HUB or reimbursement call center.

· Ability to establish close collaboration with strategic partners and peers and lead collaborative initiatives.

· Problem solving and decision-making skills with the ability to “think on feet” and suggest alternatives and solutions.

· Strong customer focus with an ability to build relationships, identify and resolved (access) challenges, and manage complex project skills.

· Ability to operate independently and successfully as a leader in a matrix environment.

· Highly organized, strategic thinker with excellent verbal and written presentation skills.

· Ability to travel to connect with customers, and field sales teams.

· Demonstrated competence with CRM systems, PowerPoint, Excel & Word.

Desired Characteristics

· Certified Professional Coding Certification.

· Experience in radiopharmaceuticals, imaging, or diagnostics.

· Product launch experience.

We will not sponsor individuals for employment visas, now or in the future, for this job opening. For U.S. based positions only, the pay range for this position is $132,000.00-$198,000.00 Annual. It is not typical for an individual to be hired at or near the top of the pay range and compensation decisions are dependent on the facts and circumstances of each case. The specific compensation offered to a candidate may be influenced by a variety of factors including skills,