Field Reimbursement Manager - Kidney (Michigan-North Ohio)

Key Duties And Responsibilities Compliantly establish connections with nephrology practice personnel (care team and administrative staff) involved in prior authorizations and specialty medication access. Partner with case management to address escalated access issues; ensure coordinated handoffs using CRM triggers and workflows. Support timely patient access by educating offices on copay, PAP, Bridge programs, and other affordability pathways. Provide follow‑up on case status and ensure offices understand insurance documentation requirements. Maintain knowledge of commercial and government prescription insurance coverage requirements, access needs, and payer trends. Conduct on‑site and virtual in‑services/training on regional payer policies, formulary updates, coverage nuances, PA/medical exception criteria, coding/billing (ICD‑10, CPT), documentation, distribution pathways, hub services, enrollment processes, and reimbursement workflows. Independently manage a multistate geographic region; prioritize accounts based on patient need, payer dynamics, and KPSP demand. Adapt engagement to existing office workflows; develop territory engagement plans to minimize access barriers. Follow non‑promotional guidelines; maintain confidentiality of patient health information and comply with applicable laws, regulations, and company policies. Knowledge And Skills Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products. Account management with HCPs/office staff; navigate payer portals and CRM/field tools. Strong communication, training, relationship‑building, analytical, and data/reporting skills. Experience executing strategic business/account plans; sound judgment; travel 50–70%. Proficiency: Microsoft Outlook/Word/Excel/PowerPoint; Salesforce CRM. Valid driver’s license and ability to meet safe driving requirements; meet healthcare industry representative credentialing. Education And Experience Bachelor’s degree in health care, life sciences, or business (advanced degree is a plus). 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field‑based access roles. Deep understanding of benefits investigations, PA processes, appeals, coverage policies, and payer ecosystems. Payer knowledge: Medicare, Medicaid, and commercial insurance plans. Pay Range $136,000 - $204,000 #J-18808-Ljbffr