Business Reimbursement Manager
Commercial | Dallas, TX | Full Time
The Business Reimbursement Manager (BRM) will support physicians and their reimbursement staff, in working with patient reimbursement for buy-n-bill models and specialty pharmacy distributed products. In addition, the BRM will serve as the primary reimbursement expert supporting the field in all areas related to reimbursement and will have local payor account responsibility. They will assist the Director of Market Access and Reimbursement and Vice President of Market Access & Reimbursement on execution of company strategies related to field reimbursement initiatives including patient and HCP on-boarding and education, compliance, resources and communication. Finally, they will work to ensure Company products are properly reimbursed and patient access reimbursement related issues are resolved in a timely manner, always exemplifying professionalism, a great attitude, conflict resolution tactics, and exceptional customer service skills. BRMs must strictly follow all compliance regulations.
- Call on key HCPOs, Hospitals and GPOs that overlay an assigned district of physician offices and hospital physicians including their reimbursement teams
- Support regional Commercial and Medicaid payors to educate clinical awareness, establish successful coverage and contract for reimbursement as directed by the VP
- Serve as an internal and external subject matter expert on all questions or issues related to billing, coding and reimbursement including knowledge of J-Code and misc. J-Code
- Educate and onboard customers on billing, coding, and national & local payer coverage policies.
- Serve as the primary customer contact for reimbursement questions and coordinate with the commercial team to provide an excellent customer experience.
- Work with Patient Service Center (PSC), provide feedback for continuous improvement by educating Sales, and Market Access colleagues to provide best in class patient experience.
- Act as local expert to all reimbursement and patient access issues in order to function as key liaison between HCPO, PSC and Sales / Marketing.
- Ability to understand and interpret Benefit Verification Requests (BVRs), interpret BVs and help resolve issues
- Educate Sales, Patient Services Center and Market Access to facilitate resolution of reimbursement issues by following established processes and policies.
- Monitor regional medical policy changes and work closely with the Market Access and the Patient Services Center to ensure company has the latest coding information, coverage policies, claims outcomes, and treatment guidelines.
- Understanding of reimbursement models as it pertains to both buy-n-bill and specialty pharmacy networks
- Previous launch experience with Misc. J codes, HCPCS codes, UB-04 and CMS1500 claim forms, reimbursement processes through Medicaid, Medicare and Commercial plans.
- Knowledge of coding, coding modifiers and ASP financial Models
- Understanding of both pharmacy and medical benefits & coverage determinations.
- Broad knowledge of healthcare documentation and medical policy guidelines
- Collaborate with all internal and external stakeholders at Verrica to ensure a high level of customer service
- Ability to educate sales at a high level to understand reimbursement issues and when to involve the BRMs in coverage / access issue.
- Ability to interpret EOBs and ensure office understands appeal process
- Strong problem solving and business acumen skills with an ability to work independently, develop strong relationships with customers, payers and internal stakeholders
- Excellent organizational, written and verbal communication skills
- Demonstrated ability to set and manage priorities as well as manage multiple projects
- Experience with Microsoft based applications, CRM, and ability to learn internal systems
- Ability to diplomatically address sensitive issues confidentially and professionally to resolve conflicts
- Ability to work consistently in a fast-paced environment
- Strong quality orientation including the ability to focus on details and adherence to compliance while ethically maintaining a business perspective Education and Training/Certification
EDUCATION AND EXPERIENCE REQUIREMENTS
- 4-year college degree in the business, health sciences, management, healthcare administration or related field
- 8+ years of experience in biotechnology, pharmaceutical, medical device, or medical/hospital management industry
- 3+ years of experience in reimbursement, billing and coding within the healthcare, biotechnology, pharmaceutical, wound care or surgical device fields
- Comprehensive knowledge of healthcare reimbursement practices, billing procedures, compliance, coding, medical terminology, coverage policies and local payer landscape
- Unwavering “patient first” mindset
- Experience launching new Biologics and innovative therapy both medical and pharmacy benefits
- Strong background in account management, or reimbursement for “buy and bill” products in the biotechnology industry related to dermatology
- Previous experience working directly with payers in the Medicaid and commercial segments
- Advanced degree (MBA, MS, etc.)
Related Work Experience:
- Certified Professional Coder
- Proficiency in other disciplines, i.e. ICD-10 & CPT Coding, medical insurance claim forms, EOBs and investigating/resolving claim denials Material & Equipment Used & Frequency
- PC and phone – daily
- Navigation of Reimbursement CRM Work Environment / Travel Requirements
- Field travel
- Office environment
- 65% travel within assigned territory, not including company meetings and conferences
Location: Field Based
Must be able to sit for extended periods of time at a desk. Normal requirements for office operations with respect to lifting, standing and walking. The position will require travel, sometimes frequent, during routine responsibilities.