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BioTissue · 4 hours ago

Sr. Manager, Field Reimbursement

Houston, TX

Full-time

Hybrid

Senior Level

5+ years exp

BioTissue is a company focused on ensuring timely and equitable access to regenerative technologies. The Sr. Field Reimbursement Manager will partner with healthcare providers to support patient access and reimbursement processes while providing education on coding and billing practices.

BiotechnologyHealth CareMedicalMedical DevicePharmaceuticalTherapeutics

Responsibilities

Partner with the commercial team and 3rd party support teams to remove barriers to patient access

Educate the Sales team and healthcare providers and office staff on benefit verification, prior authorizations, patient cost-share, and drug acquisition options

Lead scheduled calls, webinars, and virtual office hours on payer policies, common denial trends, and reimbursement best practices

Act as the primary reimbursement resource for field reps, supporting them with proactive strategies to drive utilization and payer confidence

Collaborate with Market Access leadership to develop standardized tools (coding guides, payer updates, talking points)

Guide coding, payer policies, claim approvals, and appeals for denied or underpaid claims

Monitor reimbursement trends and payer policy changes, escalating issues that may affect patient access

Lead business and claims reviews in collaboration with leadership

Maintain knowledge of and build relationships with regional and national payer landscapes, utilization management, and prior authorization processes

Communicate policy updates clearly to customers and internal stakeholders

Uphold compliance with regulatory and ethical standards related to patient assistance programs

Qualification

Reimbursement expertisePayer policy knowledgeHealthcare policy experienceCodingBilling practicesExperience in eyecareProject management skillsCommunication skillsEmotional intelligenceCollaboration skillsDetail-oriented

Required

Bachelor's degree in a related field

Minimum of 5 years of experience in market access, specialty pharmaceuticals or surgical devices in a professional capacity

Demonstrated expertise in physician-administered injectables and/or medical devices, including working with Category III CPT codes, miscellaneous J-codes, specialty pharmacy, buy-and-bill processes, benefit verification, prior authorizations, claims management, and appeals

Experience navigating coverage and reimbursement with Medicare, Medicare Advantage, commercial, and Medicaid plans

Strong understanding of healthcare provider reimbursement challenges and practice economics

Willingness and ability to travel as needed to support territory coverage, including overnight travel (~60%), and participation in required trainings and meetings

Demonstrated leadership and project management skills

Experience educating Healthcare Professionals on the availability of patient support programs such as Co-Pay Assistance and Patient Assistance Programs