Mercalis · 1 month ago
Field Reimbursement Manager
United States
Full-time
Hybrid
Mid Level
3+ years expMercalis is an integrated life sciences commercialization partner that provides comprehensive solutions spanning the healthcare value chain. As a Field Reimbursement Manager, you will help resolve patient access issues and educate healthcare provider offices on billing and coding for client products, enhancing patient access to medications.
Clinical TrialsHealth CareManufacturingMarketingPharmaceutical
Responsibilities
Solve complex patient access issues by working across the Hub, provider offices and communicating with client field team
Partner with Sales Team, Marketing, HCP, Specialty Pharmacies to create and drive strategic reimbursement support approaches, resulting in increased access to therapy for individual patients
Educate HCP and Office Staff on Patient Support Programs, per program specific operating policies and patient journey
On occasion, lead HCP offices in onsite education of program business rules, payer coverage, and other reimbursement related activities
The FRM will manage daily activities that support appropriate patient access to client’s products across relevant sites of care to work as an extension of the HUB reimbursement support services offered to providers
Review patient benefit options, prior authorization requirements, and alternate funding/financial assistance programs
Review appropriate billing and coding for products, assist with resolving reimbursement issues, and help ensure appropriate education to avoid future reimbursement hurdles
Coordinate with client’s patient support services programs representatives on patient cases and claim issues
Educate office staff on the use of client’s patient assistance and reimbursement support services, including but not limited to web-based provider programs and tools, and provide information on relevant reimbursement topics related to client’s products
Conduct policy surveillance across regional payers to ensure appropriate coding, coverage, and payment of client’s products
Assist providers with understanding local payer coverage and reimbursement trends through educational breakfast, lunch, and dinner programs
Lead sales training related to product reimbursement, as appropriate
Communicate reimbursement concerns and issues with appropriate internal stakeholders, including Sales and Managed Markets
Understand and monitor national and regional payer trends and changes
Work collaboratively with Managed Markets team to escalate potential payer issues
Operate in Compliance with HIPAA within program guidelines
On time adherence to training deadlines for all corporate policies and procedures governing access to confidential data
Ensure all SOPs are followed with consistency
Conducts miscellaneous tasks or projects as assigned
Qualification
Required
Associate's degree or higher in a related field or equivalent market experience
3+ in Pharma/Healthcare industry; working with specialty products, Hubs, Payers, HCP or related area
Must have specific practice management, billing and/or coding experience for drugs, biologicals, or devices
Must have general payer policy knowledge including public and private payers, foundational knowledge of medical benefit verifications and prior authorization/pre-determination requirements and knowledge of reimbursement processes within various sites of care
Demonstrated ability to conduct virtual and field-based reimbursement support and education
Experience with Prior Authorizations, reimbursement billing, coding, and appeals process
Knowledge of commercial payer, Medicare and Medicaid structure, systems, and reimbursement process
Strong stakeholder engagement and communication skills
Job may require up to 10% travel
Preferred
direct experience with specialty dermatology products
Company
Mercalis
Mercalis is an integrated life sciences commercialization that offers comprehensive solutions across the healthcare value chain.
501-1000 employees
Funding
Current Stage
Late StageTotal Funding
unknown2025-03-12Acquired
2011-05-18Series Unknown
Leadership Team
Scott Dulitz
Chief Executive Officer
Recent News
2026-01-20
2025-07-04
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