The Field Reimbursement Manager (FRM) is a regionally aligned, field-based position that provides reimbursement education and support for customers that utilize DEXTENZA® (and other future products) from Ocular Therapeutix. Customers may include Healthcare Providers (HCPs) within offices, ambulatory surgery centers (ASCs), hospital outpatient departments (HOPDs), and other appropriate site-of-care facilities as well as specialty pharmacies. The FRM will work closely with internal/external business partners including HCPs, billing and coding staff and other professionals involved in securing appropriate Access & Reimbursement for the use of DEXTENZA®.
The FRM provides support through (1) product-specific provider reimbursement support, (2) coordination of HUB reimbursement services, and (3) managing payer/coverage pull-through initiatives. The FRM must have a solid working knowledge of both buy-and-bill & AOB reimbursement, as well as a clear understanding of all Public and Private insurance plans and benefit design.
The FRM is expected to be a subject matter expert on access & reimbursement processes pre/post CMS C-Code status (i.e., benefit verification, prior authorization, claim assistance, and appeals). In addition, the FRM needs to build and maintain strong relationships with provider practices and facilities, while implementing and managing field reimbursement responsibilities. The FRM role includes a high degree of communication, account coordination and cross-functional collaboration.
Essential responsibilities of the FRM include:
•Proactively educate prescriber office personnel so they may help patients gain access to our products. Educate on coding of DEXTENZA® (CPT, ICD9-ICD10, HCPCS) and how to pull-through using miscellaneous C-codes and J-codes, including payer specific instructions on reimbursement/billing for new drugs/biologics described by a miscellaneous code, using PRC approved materials.
•Reactively address access and reimbursement issues and provide necessary education for them to secure appropriate reimbursement and access
•Provide PRC approved information related to product coverage, which may include payer specific requirements for claims processing, information regarding prior authorizations and the appeals process, as well as general information regarding disease state
•Interact with healthcare professionals, to understand access and reimbursement issues and work toward resolution. Maintain communication with all cross-functional partners throughout interactions and follow through to resolution.
•Interact regularly with Regional Account Directors and Key Account Managers, to provide field intelligence and disseminate payer policy and positive advantages
•Coordinate with field sales regarding prioritization of accounts to ensure targeted, timely lists of key accounts. Ensure ongoing communication with field sales regarding account follow-up plans.
•Serve as a primary point of contact for Market Access team for distribution and payer issues
•Act as the HUB liaison to educate customers on appropriate available patient support programs. Explain financial assistance and other funding options available to patients for Ocular products. Help the practice understand how to enroll patients in appropriate programs. Advocate for DEXTENZA® HUB utilization for patient-specific access support needs.
Internal and External Contacts:
The FRM must work effectively with multiple internal & external stakeholders in a matrix environment to achieve target objectives and meet established MBO’s/goals.
Internal: Field Sales, Managed Markets, Marketing, other Patient Services teams (including outsourced HUB services), and MSL (as needed)
External: HCPs, HOPDs, ASCs, pharmacy, and billing/coding staff associated with key customers
•Education: BA/BS degree required
•Minimum 5-7 years of prior field-based reimbursement and access experience required
•Minimum 3 years of other related pharma/biotech experience strongly preferred (e.g., Market Access, Sales, Product Marketing)
•Prior experience launching specialty therapeutics in “buy and bill” environment
•Comprehensive understanding of both medical benefit and pharmacy benefit policies across payer types (Medicare, Medicaid, commercial, VA/DoD, etc.) and sites of care (HOPD, ASCs)
•Ability to lead without authority within cross-functional groups and in a matrix organization
•Exceptional professional communications and interpersonal/problem-solving skills necessary to interact with key decision makers (CFO and other c-suite level stakeholders)
•Demonstrated ability to identify key access barriers and design effective resolution plans
•Ensures compliance with all corporate and industry policies in collaboration with Legal, Regulatory and Compliance Qualifications
•Desire to innovate and work in a fast-paced, energetic environment
•Candidates must live near a major airport and be willing and able to travel approximately 70-75% of the time (average 3-4 days per week); territories to include: Dallas, Houston, Chicago, St Louis