Field Reimbursement Manager - East Region

Position Summary

The Field Reimbursement Manager (FRM) serves as the subject-matter expert on reimbursement, access, and coverage issues for our products, primarily focusing on Nephrology and potentially other therapeutic areas. This role operates as a crucial liaison between healthcare providers (HCPs), internal teams, and external stakeholders to facilitate appropriate patient access to our products.

Key Responsibilities

• Educate HCPs and their staff on matters related to access, coverage, reimbursement processes, claims submissions, and coding requirements
• Analyze payer criteria and provide product access expertise to healthcare offices
• Coordinate with Hubs on individual patient cases, including patient support services and enrollment
• Collaborate with Field Sales, Specialty Pharmacy Accounts, and other matrix partners
• Manage daily field-based activities, spending 60-70% of time interacting with key stakeholders across various care sites
• Execute collaborative territory plans through partnerships with internal and external stakeholders
• Review and educate offices on payer policies, including prior authorization requirements
• Provide feedback to internal teams on local payer trends and access issues
• Assist in resolving patient-specific coverage challenges when requested by healthcare providers

Qualifications Required

• Minimum 5 years of pharmaceutical industry experience, with focus on payer policy and reimbursement
• At least 3 years of experience in benefit verifications, prior-authorization requirements, or equivalent experience in patient access, billing, and coding in rare disease
• Strong knowledge of Centers for Medicare & Medicaid Services (CMS) policies and processes, especially Medicare Part D
• Experience in "Buy and Bill" reimbursement environment
• Nephrology experience strongly preferred
• Comprehensive understanding of US healthcare system payer billing practices
• Proficiency in MS Office suite

Qualifications Preferred

• Bachelor's degree

Skills and Abilities

• Excellent verbal and written communication skills
• Strong interpersonal and consultative abilities
• Self-directed with outstanding organizational skills
• Ability to build and maintain strong relationships with internal and external customers
• Proficient in delivering training and presentations

Travel Requirements

• Ability to travel up to 60-70% domestically
• Valid driver's license required

Competencies
Accountability for Results - Stay focused on key strategic objectives, be accountable for high standards of performance, and take an active role in leading change.
Strategic Thinking & Problem Solving - Make decisions considering the long-term impact to customers, patients, employees, and the business.
Patient & Customer Centricity - Maintain an ongoing focus on the needs of our customers and/or key stakeholders.
Impactful Communication - Communicate with logic, clarity, and respect. Influence at all levels to achieve the best results for Otsuka.
Respectful Collaboration - Seek and value others’ perspectives and strive for diverse partnerships to enhance work toward common goals.
Empowered Development - Play an active role in professional development as a business imperative.

Minimum $117,027.00 - Maximum $167,420.00, plus incentive opportunity: The range shown represents a typical pay range or starting salary for candidates hired to perform the work. Other elements may be used to determine actual salary such as the candidate’s job experience, specific skills, and comparison to internal incumbents currently in role. This information is provided to applicants in accordance with states and local laws.

Company benefits: Comprehensive medical, dental, vision, prescription drug coverage, company provided basic life, accidental death & dismemberment, short-term and long-term disability insurance, tuition reimbursement, student loan assistance, a generous 401(k) match, flexible time off, paid holidays, and paid leave programs as well as other company provided benefits.

Come discover more about Otsuka and our benefit offerings;