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:
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