Field Reimbursement Manager Tzield- Northeast Region

Job Title: Field Reimbursement Manager Tzield- Northeast Region

Location: Remote

About the Job

The individual in this role will need to demonstrate a deep passion for patients and caregivers with an emphasis on enhancing and optimizing the patient and prescriber experience with our support program offerings.  Moreover, since this is a foundational role, this individual will need to quickly establish compliant relationships with patients and providers, helping to ensure successful access to the prescribed treatment. Lastly, to be successful in this role, strong and compliant cross-functional collaboration with Sales and other commercial team members is essential.

The Tzield reimbursement environment is highly challenging for Health Care Providers (HCPs) and Patients. Payer medical and pharmacy Utilization Management (UM) criteria create process delays for patients like required Benefits Investigations (BI), Prior Authorization (PA), Denial Appeals, detailed Clinical Documentation, and Peer to Peer reviews. Assisting HCPs and Patients to gain access to prescribed treatments requires dedicated and knowledgeable customer facing support.

Field Reimbursement Manager/Director for TZIELD. This is a regionally aligned, field-based position that provides reimbursement education and support for customers that utilize TZIELD (and other future products). You will act at the subject matter export on access, reimbursement, billing and coding processes and providing support through (1) product-specific provider reimbursement support, (2) coordination of HUB/Patients Services reimbursement services, and (3) managing payer/coverage pull-through initiatives.

We are an innovative global healthcare company, committed to transforming the lives of people with immune challenges, rare diseases and blood disorders, cancers, and neurological disorders. From R&D to sales, our talented teams work together, revolutionizing treatment, continually improving products, understanding unmet needs, and connecting communities. We chase the miracles of science every single day, pursuing progress to make a real impact on millions of patients around the world.

Main Responsibilities:

 Key responsibilities for a TZIELD FRM within Gen Meds will be:

• Work closely with patients/caregivers and providers to gain access to therapy

• Be the single point of contact for patients, caregivers, and providers in the assigned region

• Back-up colleagues and collaborate across patient services team

• Successfully and compliantly enroll patients into the program

• Perform Benefit Verifications, Prior Authorization follow-up, and Appeal follow-up

• Counsel patient/family on reimbursement options and financial assistance options

• Manage general inquiries via phone or email

• Work with specialty pharmacies and specialty distributors

• Coordinate with different sites of care, including infusion centers

• Manage the transition from infusion site to in-home infusion therapy as appropriate

• Maintain case history for all assigned patients in the CRM system

• Troubleshoot and resolve ongoing reimbursement issues (insurance changes, PAs, other)

• Record and report Adverse Events and Product Complaints

• Manage replacement requests from HCPs

• Perform data entry, answer and make outbound calls, utilize email, fax and SMS to correspond with patients and HCPs as appropriate

• Proactively communicate specific patient support offerings, utilizing MLR-approved materials

• Schedule time with HCPs in the field or over Zoom to educate and/or work through reimbursement challenges

• Educate HCPs and staff on product procurement through SP or Buy/Bill, site of care, and billing/coding

• Inform HCPs and office staff of approved billing and reimbursement information using MLR-approved items (J-codes, EOBs, co-pay programs, etc.)

• Provide HCPs with compliant information and coverage guidance to help address coverage and reimbursement matters

• Stay educated about compliance and OIG guidance and policies regarding patient support programs and offerings

• Attend patient meetings and represent Sanofi at industry conferences

• Travel to national meetings and medical offices as needed

• Establish and maintain knowledge on the local and national payer landscape, including Specialty Pharmacy and Utilization Management criteria for TZIELD

• Reactively address access and reimbursement issues and provide necessary education for them to secure appropriate reimbursement