Field Reimbursement Manager

Job Title

Requisition

Location

Additional Locations

Job Description Summary

Job Description

Provider Account Support

• Critical point person for all reimbursement and acquisition logistical aspects of a high touch biologic medication for an orphan disease, and testosterone products with multiple acquisition options within a changing payer landscape.
• Assists HCP offices with questions related to Buy/Bill BI management. Educate/Assist with Specialty Pharmacy understanding, expectations and logistics. Continually educate office staff on appropriate steps, educate on the importance of chart documentation, keep offices up to date on payer policies for KEENOVA products and triage issues to the appropriate HUB and Specialty Pharmacy
• Primary responsibilities include:
  • Managing patient assistance and reimbursement support services offered to providers and related to patient access to buy/bill products.
  • Coordinating with Keenova's patient support services program representatives.
  • Educating office staff on the use of Buy/Bill products patient assistance and reimbursement support services.
  • Participating in sales training related to product reimbursement.

• Utilizing data to critically think through acquisition challenges from a variety of outlets including Specialty Pharmacies, Specialty Distributors and Title sales.
• Assist new offices from a reimbursement perspective to inform them about reimbursement issues as well as education on various MARC approved resources pertaining to reimbursement, acquisition and coding.

SP Support

• FRMs work closely with the external and internal customers to trouble shoot any SP related issues. FRMs to work closely with their NAE partner to manage any customer related issues directly with the SP's.
• Specialty Pharmacy experience is critical. Each FRM should be an expert in Specialty Pharmacy logistics and operations.
• FRMs must be able to analyze data and know how to make that data into actionable steps to facilitate patient access to KEENOVA products.
• Work closely with Specialty Pharmacies to understand logistical issues that arise and provide MARC approved resources and programs to facilitate patient access as well as communicate with SP's to find resolutions to issues that arise at the SP.
• Identify gaps in knowledge of accounts from a Specialty Pharmacy process and help provide education for the account and physician.

Internal Partnerships

• Consistent, reliable, timely and high-quality support of the field, as well as all other internal commercial functions.
• Strong leadership role to the field teams by establishing a solutions oriented approach, working with your Sales Representatives/DM to build and execute on local plans to overcome barriers to Buy/Bill products access. Specific examples include:
  • Identify in conjunction with the field, specific targeted accounts where the FRM will assist with product acquisition or SP dispense.
  • Partner with the DM's to build local business plans; participate in district business reviews as the expert resource on the reimbursement landscape from regional, district, state and local perspective.
  • Provide the teams with actionable feedback (across the organization) on support programs such as the Helpline, copay card, SPP performance, so as to guide changes to improve access.
  • Help educate the internal customers on managed market dynamics specific to SP's/SD's as well as local payor issues-needs. Track customer trends in order to help inform internal business decisions. (E.g. Health care policy changes...).
  • Proactively use business analytics to understand common logistical issues in top accounts and proactively develop plans for education and to find solutions for better patient access to Xiaflex, AVEED, Testopel and SLA. Ensure alignment with DM and District Strategy.
  • Provide support to sales representatives and District Managers/Internal Stakeholders on rules of engagement to educate and further clarify what is appropriate.

Advocacy

• The FRM works with the field to identify potential payer advocates and supports the National Account Management team on issues relating to medical policy development and execution at the HCP level.
• Ensure all Keenova approved promotional speakers have an in-depth understanding of billing/coding, logistics and payer coverage.

Other duties as assigned.

Qualifications

Education & Experience

• BS or equivalent, MBA or advanced degree ideal.
• 5-7 years of relevant experience.
• Previous experience working with vendor relationships desirable.
• Previous experience managing customer interactions.
• Previous sales management and/or account management experience highly desirable.

Knowledge

• Systemic understanding of the global payer and distribution environment, in particular, biologic In-Office Injectables (IOI) in the U.S.
• Understanding of coverage, coding (diagnostic, procedural and product), payment and reimbursement requirements and policies.
• Knowledge / expertise in Local Coverage Determinations (LCDs) per each regional MAC for all KEENOVA products.
• Knowledgeable on Medicare billing/coding and appeal process. ASP, WAC as well as Sequestration; interpret and understand Medicare EOBs and CMS 1500 forms.
• Understands the legislative, legal and regulatory environments and anticipates potential impact to Keenova.
• Solid understanding of coverage policy creation, interpretation and management.

Skills & Abilities

• Significant sales experience in the biologic (injectable) market.
• Ability to synthesize clinical literature and target product profile in order to understand implications for value to payers, patients and health care providers and Keenova.
• Strong written and verbal communication skills, with an ability to condense complex information into concise outputs and direction.
• Ability to work with health care providers and insurers to explain and help manage all issues related to product access.
• Ability to balance external stakeholders' wants with Keenova needs.
• Hands-on operational reimbursement experience - in-house and outsourced experience desirable.
• Demonstrated ability to work with multiple stakeholders in a collaborative and constructive manner. Establishes relationships with appropriate field personnel, accounts, payers and vendors.
• Comfortable working in a transparent environment (fair balance, full disclosure, Safe Harbors, etc.)

Working Conditions

• Significant travel involved.
• The role is field based, ideally living in the Little Rock, AR area.

Keenova offers employees a Total Rewards package which includes competitive pay and benefits. To learn more about our Total Rewards benefits please visit: Keenova Careers | Serve and Grow with Purpose | Keenova

This position is eligible for a bonus in accordance with the terms of the applicable program. Bonuses are awarded at the Company's discretion.

Disclaimer: The above statements are intended to describe the general nature and level of work performed by employees assigned to this job. They are not intended to be an exhaustive list of all duties, responsibilities, and qualifications. Management reserves the right to change or modify such duties as required.

At Keenova, we believe that no one should be alone in their pursuit of better health. This purpose drives us as we pair quality therapeutics with human support-showing up in big moments and small to help patients find comfort and confidence.

We bring deep expertise and resolve to every therapeutic area we serve, including immunology, urology,men's health, orthopedics, critical care, and pediatric endocrinology. We work with patients, care partners, and physicians to help them navigate healthcare system complexity and access therapies that make a meaningful difference.

We are Keenova-keen to solve, keen to serve. Learn more atwww.keenova.com.