Valeant Pharmaceuticals

Field Reimbursement Manager - West

US-FIELD
Job ID
9532
Category
Marketing
Pos. Type
Full Time

Overview

Valeant Pharmaceuticals International, Inc. is a diverse and decentralized pharmaceutical company that is committed to focusing on our key stakeholders while delivering consistently high performance. Our values provide the overall direction for our company, and provide us with the tools necessary to rise to any challenge by leveraging our collective hard work and effort along with our unwavering competitive spirit. These values help us set goals based on our organization’s potential and what we hope it will become.

Responsibilities

The Field Reimbursement Manager (FRM) will provide field-based support and expertise to help resolve patient access issues, educate offices and hospitals on appropriate billing and coding for Valeant Pharmaceuticals, Inc. products, and provide educational services within relevant sites of care. The FRM will work directly with office support staff, hospital billing and coding staff, third party vendors (Helpline, Copay Card, Patient Assistance Program (PAP), and other important stakeholders involved with supporting patient access to Valeant Pharmaceuticals, Inc. therapies. FRMs will develop Key Opinion Leader (KOL) relationships, be involved in payer monitoring and support across Medicare Contractors, and lead the relationship with Medicare Contractor Medical Directors.

  • The FRM will manage daily activities that support appropriate patient access to Valeant Pharmaceuticals, Inc. products across relevant sites of care to work as an extension of the patient assistance and 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 Valeant Pharmaceuticals, Inc. patient support services programs representatives on patient cases and claim issues.
  • Educate office staff on the use of Valeant Pharmaceuticals, Inc. 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 Valeant Pharmaceuticals, Inc. products.
  • Help develop KOL relationships in collaboration with Territory Managers (TMs) and Regional Account Managers (RAMs) related to payer initiatives.
  • Monitor and attend Open Contractor Administrative Committee (CAC) Meetings for designated Medicare Administrative Contractors (MACs)
  • Conduct policy surveillance across regional MACs to ensure appropriate coding, coverage, and payment of Valeant products.
  • Attend and support relevant regional society meetings, coordinating support with TMs and Brand.
  • 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.
  • Coordinate travel schedules to attend important access meetings with Sales Force.
  • Conduct pre-call planning meetings with TMs to ensure objectives and goals for each visit are established.

Dimensions

  • Company-wide liaison with Third Party Hub Service Provider(s) and Valeant’s customers.
  • Internal Contacts: Daily interaction with appropriate Sales Force and leadership, Key Account Managers (KAMs), Managed Markets Account Managers, and direct manager.

Latitude

  • This position requires the ability to act independently and to take initiative with minimal supervision from manager.
  • Provide consultative reimbursement support to internal and external stakeholders.
  • Able to troubleshoot reimbursement issues.
  • Ability to diffuse situations within an office or hospital due to reimbursement concerns.
  • Tailor approach and message to relevant stakeholders (i.e., nurse vs HCP vs biller)
  • Advise manager of work schedule, priorities, problems, and of planned and unplanned absences.

Qualifications

Education:

Bachelor’s degree required, advanced degree preferred.

 

Experience:

  • Minimum of two years of experience in public or private third party reimbursement; previous field reimbursement manager experience preferred.
  • Must have worked with a pharmaceutical, biotech, or device manufacturer sales team in a reimbursement capacity or as a contract position through a reimbursement consulting agency.
  • Must have specific practice management, billing and/or coding experience for drugs, biologicals, or devices under a “buy & bill” and specialty pharmacy model.
  • Must be able to assist prescribers and their staff with addressing barriers to appropriate patient access to Valeant’s products, which requires a broad knowledge of the claims revenue cycle process.
  • The FRM must also possess an understanding of reimbursement considerations from a patient and provider perspective, with an ability to effectively interact and navigate within various sites of care (i.e., physician office, hospital outpatient department, ambulatory surgery center, etc.).
  • Must have general payer policy knowledge including public and private payers, foundational knowledge of benefit verifications and prior authorization/pre-determination requirements and knowledge of reimbursement processes within various sites of care.
  • All reimbursement activities are required to be conducted and managed within all appropriate legal and regulatory guidelines and require continuous monitoring of compliance with such guidelines and laws.

Skills and Abilities:

  • Public speaking / presentations / education experience required
  • Ability to develop relationships with medical directors within a payer.
  • Demonstrated ability to conduct field-based reimbursement support and education
  • Experience with reimbursement billing, coding, and appeals process.
  • Experience with new product launches, including billing with a miscellaneous HCPCS code, miscellaneous CPT code, and / or transition to billing with a unique HCPCS code
  • Knowledge of private payer, Medicare and Medicaid structure, systems, and reimbursement process.
  • Ability to analyze and interpret regulation and legislation.
  • Project management skills.
  • Ability to work independently, manage travel schedules, schedule visits (territory management).
  • Ability to travel overnight for three nights per week.
  • Strong computer skills (PowerPoint, Word, Excel).
  • The FRM should have a travel expectation of 50-70%.
  • You may be required to provide hospitals proof of childhood immunizations, a negative TB test and other requirements, as set by the hospital protocol for access.

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