Field Reimbursement Manager - Pittsburgh
Job Summary - a concise overview of the job
The Field Reimbursement Manager (FRM) is a critical front-line member of the Endo Access and Reimbursement team who represents Endo’s interest with Xiaflex, Testopel, Aveed and Supprelin LA with HCP accounts, as well as all internal Endo stakeholders and field sales personnel. The FRM will be an expert and provides education, training and hands-on assistance related to access of the above products.
All incumbents are responsible for following applicable Division & Company policies and procedures.
Scope of Authority - span of control (work unit, site, department, division, etc.), monetary value of budget/spend authority ( capital, operating, etc.), P&L responsibility, etc.
Endo Branded – Specialty
Key Accountabilities - key outcomes/deliverables, the major responsibilities, and % of time
% of Time
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 (SP) 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 Endo products and triage issues to the appropriate HUB and SP.
§ Primary responsibilities include:
o Managing patient assistance and reimbursement support services offered to providers and related to patient access to buy/bill products.
o Coordinating with Endo’s patient support services program representatives.
o Educating office staff on the use of Buy/Bill products, patient assistance and reimbursement support services.
o Participating in sales training related to product reimbursement.
§ Utilizing data to critically think through acquisition challenges from a variety of outlets including SP, Specialty Distributors and Title sales.
§ Assist new offices from a reimbursement perspective to inform them about reimbursement issues as well as providing education on various MARC approved resources pertaining to reimbursement, acquisition and coding.
Specialty Pharmacy (SP) Support
§ FRMs work closely with the external and internal customers to trouble shoot any SP related issues. FRMs work closely with their NAE partner to manage any customer related issues directly with the SP’s.
§ SP experience is critical. Each FRM should be an expert SP 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 ENDO products.
§ Work closely with SP’s 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 SP process and help provide education for the account and physician.
§ 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/ASMs to build and execute local plans to overcome barriers to Buy/Bill products access. Specific examples include:
o Identify in conjunction with the field, specific targeted accounts where the FRM will assist with product acquisition or SP dispense.
o Partner with the ASMs 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.
o 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.
o 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.
o 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 ASM and District Strategy.
o Provide support to sales representatives, ASMs and Internal Stakeholders on rules of engagement to educate and further clarify what is appropriate.
§ 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 Endo approved promotional speakers have an in-depth understanding of billing/coding, logistics and payer coverage.
§ Other duties as assigned.
Education & Experience
Minimal acceptable level of education, work experience and certifications required for the job
§ BS or equivalent is required; MBA or advanced degree ideal.
§ 5-7 years of relevant experience in the Biopharma industry required.
§ Previous experience working with vendor relationships desirable.
§ Previous experience managing customer interactions.
§ Previous sales management and/or account management experience highly desirable.
§ All newly hired FRMs should enter at this level regardless of their tenure or experience elsewhere
Proficiency in a body of information required for the job
e.g. knowledge of FDA regulations, GMP/GLP/GCP, Lean Manufacturing, Six-Sigma, etc.
§ 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 ENDO 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 Endo.
§ Solid understanding of coverage policy creation, interpretation and management.
Often referred to as “competencies”, leadership attributes, skills, abilities or behaviors that may be enterprise, functional or job specific e.g. coaching, negotiation, calibration, technical writing etc.
§ 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 Endo.
§ Strong written and verbal communication skills, with an ability to condense complex information into concise outputs and direction.
§ Ability to have payer conversations with commercial and government payers, drawing on the understanding of Endo products, payer policy appeals process, and the payer landscape
§ Ability to balance external stakeholders’ wants with Endo 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.
§ Models Endo’s vision and core values and encourages others to foster a culture of compliance
§ Learns how to conduct business at the c-suite level for large hospital systems and can address more routine policy and State Medicaid and Medicare problems.
Physical & mental requirements e.g. lift 40 pounds, walk across plant/warehouse, business travel (% of time), driving as part of work responsibilities, etc.
§ Significant travel involved.
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.