Remote Reimbursement Manager (RRM)

WHO WE ARE

Phluence™ (formerly Lifelink Systems) is an advanced agentic workflow management platform designed to virtualize patient and HCP engagement. Learn more:

ABOUT THE ROLE

The Remote Reimbursement Manager (RRM) is a non-promotional, field-based professional responsible for educating healthcare providers (HCPs) and their administrative staff on the complex reimbursement landscape. You will serve as the primary subject matter expert on patient access, navigating insurance coverage, coding, and the support program to ensure patients with OUD can start and stay on therapy.

KEY ACCOUNTABILITIES

HCP & Staff Education

• Workflow Optimization: Train office staff, billing managers, and hospital administrators on two primary acquisition channels for: Buy-and-Bill (Specialty Distribution) and Specialty Pharmacy (SP) workflows.
• Coding & Billing Expertise: Provide expert guidance on the correct use of HCPCS codes (e.g., J-codes for long-acting buprenorphine), CPT codes for administration (96372), and ICD-10 diagnosis codes.
• REMS Coordination: Educate offices on the administrative requirements of the REMS program to ensure compliant ordering and dispensing.
• Payer Nuance Education: Guide healthcare providers and administrative staff through the distinct coverage policies, documentation requirements, and reimbursement nuances across various payer types, including Commercial, Medicare, and Medicaid.

Access & Reimbursement Support

• Payer Landscape Navigation: Provide real-time updates on local, regional, and national payer policies (Commercial, Medicare Part D, and Medicaid "carve-outs").
• Prior Authorization (PA) & Appeals: Assist practices in understanding PA criteria and the documentation necessary for medical or pharmacy benefit appeals.
• Support Program Advocacy: Educate and assist providers and office staff on access support and copay assistance for commercially insured patients, while identifying financial support options for those in need.

Compliance & Ethics

• 42 CFR Part 2 Mastery: Ensure all interactions involving patient data adhere to the strict federal confidentiality standards for SUD records.
• Non-Promotional Boundaries: Maintain clear separation between clinical/reimbursement support and sales/marketing activities, adhering to all PhRMA guidelines and compliance policy.

Strategic Territory Management

• Cross-Functional Partnership: Appropriate collaboration and coordination with Field Sales and Market Access teams to identify and resolve systemic reimbursement barriers within the region.
• Account Prioritization: Strategically manage a high-volume territory, focusing on Opioid Treatment Programs (OTPs), Community Health Centers (FQHCs), and high-prescribing private practices.
• Account Planning & Service: Appropriate account planning with Field Sales overlaps is necessary for successful customer outcomes. RRMs must plan to meet with Field Sales representatives on a regular cadence to share account logistics and discuss appropriate outcomes from sales escalations.
• Market Insights & Reporting: Gather and report market access insights, payer policy changes, and emerging reimbursement trends to Market Access Leadership to inform ongoing strategy.

QUALIFICATIONS & SKILLS

• Education: Bachelor’s degree required (BS/BA). Advanced degree (MPH, MBA, MHA) preferred.
• Experience: 5+ years in pharmaceutical or biotech industry, including at least 3 years in Field Reimbursement, Patient Access roles or responsibilities, or Specialty Pharmacy in biotech or demonstrating these capabilities within the HCP practice. 
• Therapeutic Knowledge: Prior experience in Substance Use Disorders, Central Nervous System,, or Pain Management is highly desirable.
• Technical Expertise: Strong understanding of "Buy-and-Bill" economics and specialty distributor models.
• Proficiency in navigating Medicaid managed care and Medicare with live examples of resolving Medicaid access challenges.
• Preferred experience: Experience with injectable medications, REMS, navigating a challenging commercial landscape, and familiarity with various sites of care (including Opioid Treatment Centers, Outpatient Facilities, Primary Care and Community Health Centers, Residential Treatment Centers).
• Familiarity with CRM tools (Veeva/Salesforce) for tracking account interactions preferred.
• Travel: Ability to travel up to 15% within the assigned territory, including overnight stays when necessary.

LOCATION 

Remote 85% of the time and territory travel will be small but strategic. 

Candidates must be able to work in Eastern Standard Time hours.

All qualified candidates will be considered, preference for candidates working in or near the Blue Ridge and Southeast Regions of the United States.

REPORTING

Direct line reporting to Phluence with dotted line reporting to Market Access Leadership

COMP & BENEFITS

Phluence offers a comprehensive benefits package designated to support employees and their families, including: 

• Competitive salary range of $140,000 to $155,000
• Comprehensive medical, dental, and vision coverage
• Paid time off
• Paid company holidays
• Sick leave
• Travel and expense reimbursement

Please apply on LinkedIn before October 29th

The starting date for this position is planned for January 2027.