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Inizio Engage · 1 day ago

Field Reimbursement Manager

Hartford, CT

Full-time

Hybrid

Mid Level

3+ years exp

Inizio Engage is a strategic partner specializing in healthcare, and they are seeking a Field Reimbursement Manager to educate healthcare providers on prior authorization and appeals processes. This field-based role involves collaboration with sales and other partners to enhance patient access and support for a product in the men’s health space.

CommercialHealth CareHospital

Responsibilities

Educate HCPs and appropriate office staff about product specific prior authorization & appeals process, how to access related forms, and high-level information about submission procedures and reauthorization requirements

Work with in-network Specialty Pharmacies on cases where the patient has provided consent

Educate HCPs and appropriate office staff on specific referral processes and patient assistance programs

Work closely with sales and other matrix partners to identify additional accounts with need for education

Utilize approved resources and FAQs to provide education and answer questions as needed

Solid understanding of reimbursement issues that work within our core classes of trade:

+ Commercial Managed Care (Regional Plans)

+ Medicaid (Fee for Service, Managed Care Organizations)

+ Medicare (Part A, B, C, D; Carriers)

+ Veteran’s Administration (VISNs)

+ TRICARE Regional Offices

+ Specialty Pharmacy & Pharmacy Benefit Managers

+ ACOs and other Integrated Delivery Networks (IDNs)

+ Advocacy, consumer, provider and treatment systems groups

Document interaction details within CRM with attention to data integrity to ensure compliance with program policies and business rules

Maintain confidentiality of Patient Health Information (PHI) and act in compliance with all laws, regulations, and company policies

Adhere to all Inizio and client policies, procedures, business rules, and call guides, as well as applicable laws

Qualification

Reimbursement knowledgePatient access experienceField-based role experienceSpecialty pharmacy knowledgePayer reimbursement modelsMulti-tasking abilityPassion for learningAttention to detailCommunication skillsOrganizational skills

Required

BS/BA required

3+ years of relevant experience in – reimbursement and patient access, market access, specialty pharmacy, or physician/system account management

Proven success operation in a field-based role

Strong knowledge and understanding of payer reimbursement models (medical and pharmacy), prior authorization and appeal requirements, coding changes, appropriate claim submission, integration of HUB and patient assistance programs

Maintains compliance with program business rules, standard operating procedures and guidelines

Highly organized with excellent attention to detail and the ability to multi-task in engaging both patients and providers

Passionate about learning and able to share/communicate that passion to others

Experience engaging HCP staff in a support role to educate on access pathways and product requirements

Experience navigating payer reimbursement process, preferably Medicare Part D (pharmacy benefit design and coverage policy)

Preferred

Experience in endocrine or men's health disorders preferred

Benefits

Competitive compensation

Excellent Benefits – accrued time off, medical, dental, vision, 401k, disability & life insurance, paid maternity and paternity leave benefits, employee discounts/promotions

Employee discounts & exclusive promotions

Recognition programs, contests, and company-wide awards