Access & Reimbursement Manager

Serve as a dedicated access and reimbursement resource within an assigned territory Educate provider offices and office staff on payer requirements, reimbursement processes, patient support services, and approved access resources Support appropriate patient access for client products, including access and reimbursement issue resolution as authorized Develop and execute a territory access plan and prioritize accounts based on client-defined objectives Coordinate compliantly with sales, market access, patient services, hub/specialty pharmacy partners, and other matrix stakeholders Document activities in the approved CRM platform Provide education on Retail and Specialty Pharmacy prior authorizations, appeals, and denials Provide in-person customer visits and participate in client, internal, and cross-functional meetings and calls Monitor payer policy, formulary coverage, utilization management requirements, pharmacy access pathways, prior authorization trends, denial patterns, and other access barriers Communicate relevant payer changes and field insights to internal stakeholders Provide office education on formulary criteria, coding, insurance forms and procedures, benefits investigation, prior authorization, appeals, and claims resolution Use only client-approved materials, messaging, processes, and resources Identify and communicate field access insights, payer trends, office workflow barriers, and reimbursement challenges Recognize and report adverse events, product complaints, and other reportable information according to policy and applicable requirements Requirements 3+ years of experience in Managed Care, Field Reimbursement, Patient Services, Specialty or Biologics Sales, or healthcare provider office practice management 4-year degree in related field or equivalent experience Cardiovascular/Cardiology and Hospital Healthcare Systems experience a plus Ability to travel 3-4 days a week, with overnights as needed, and reside within the Territory Solution-oriented mindset, strong business acumen, and strong analytic capabilities Experience and understanding of Retail Pharmacies and Specialty Pharmacies Demonstrated ability to educate offices on access processes and issue resolution Experience educating HCPs and office staff on client-specific Patient Service programs, such as copay programs Experience delivering educational presentations in person and/or via Zoom, Webex, or Teams Advanced knowledge of medical insurance terminology Knowledge of CMS policies and processes, with expertise in Medicare Part D for Pharmacy Benefit products Ability to develop and maintain trusted relationships with internal partners and work effectively in teams Ability to manage ambiguity and problem solve Ability to prepare and submit appropriate expense reports in a timely fashion Valid Driver’s License Core Competencies Demonstrates expertise in access and reimbursement processes, with a strong focus on educating healthcare providers and office staff. Proficient in developing territory access plans and navigating payer policies to enhance patient access to client products. Highest-signal resume keywords Managed Care Experience Field Reimbursement Expertise Patient Services Knowledge Advanced Medical Insurance Terminology Education and Training Skills Hard Skills Access and Reimbursement Processes Prior Authorization Knowledge Claims Resolution Formulary Coverage Understanding Analytic Capabilities Patient Support Services Coding and Insurance Forms Payer Policy Monitoring Expense Report Preparation Healthcare Provider Education Soft Skills Solution-Oriented Mindset Strong Business Acumen Ability to Manage Ambiguity Relationship Building Team Collaboration Industry Keywords Cardiovascular Cardiology Hospital Healthcare Systems CMS Policies Medicare Part D Retail Pharmacy Specialty Pharmacy Patient Service Programs Tools & Technologies CRM Platform Zoom Webex Microsoft Teams #J-18808-Ljbffr Jobtailor