Virtual Access & Reimbursement Manager

United StatesRemotemid

OtherManager

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Quick Summary

Overview

About Stratis Group: Stratis Group is an independent pharmaceutical consulting firm that specializes in commercialization throughout a brand’s lifecycle, our core passions include: market access,

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OtherManager

Responsibilities

~2 min read

→Manage daily activities virtually (via phone, Zoom, Webex, or Teams, etc.) that support appropriate patient access to our client’s products in the provider offices and work as a liaison to other patient assistance and access support services offered by our clients.
→Support field vacancies, white space, and overflow case management virtually via phone, (Zoom, Webex, or Teams, etc.).
→Rapidly assume responsibility for new territory assignments while maintaining consistent program execution and customer support.
→Expert in providing general education on Retail and Specialty Pharmacy drug Prior Authorizations, Appeals, and Denials
→Participate in client meetings as appropriate. Participate in regularly scheduled internal team and cross-functional meetings and calls. Input call activity into customer CRM, as appropriate.
→Serve as the access and reimbursement expert for the current assigned geography, monitoring payer policy, formulary coverage, utilization management requirements, pharmacy access pathways, prior authorization trends, denial patterns, and other access barriers. Communicate relevant changes and field insights to appropriate internal stakeholders in a timely and compliant manner. Provide office education and awareness during the entire access process which may include formulary coverage/utilization management criteria, coding, insurance forms & procedures, benefits investigation, prior authorization, appeal, and/or claims resolution.
→Use only client-approved materials, messaging, processes, and resources when engaging with healthcare providers, office staff, and field partners.

→Identify and communicate field access insights, payer trends, office workflow barriers, and reimbursement challenges to appropriate internal stakeholders to support continuous improvement
→Recognize and report adverse events, product complaints, and other reportable information in accordance with client policy and applicable requirements.

Requirements

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3+ years of experience in one or more of the following areas: Managed Care, Field Reimbursement, Patient Services, and/or Sales (Specialty or Biologics), or healthcare provider office practice management
4-year degree in related field or equivalent experience

Demonstrated ability to quickly integrate into new business environments, adapt to changing coverage needs and territory priorities, and maintain consistent customer support and program execution in a dynamic environment.

Cardiovascular/Cardiology and Hospital Healthcare Systems experience a plus
Solution oriented mindset, strong business acumen, & strong analytic capabilities
Experience and understanding of Retail Pharmacies & Specialty Pharmacies
Demonstrated ability to educate offices on access processes and issue resolution
Experience educating HCPs and office staff on client specific Patient Service programs (i.e. copay)
Experience delivering educational presentations in person and/or via technology platforms such as Zoom, Webex, and/or Teams
Advanced knowledge of medical insurance terminology
Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare (Part D for Pharmacy Benefit products)
Proven ability to develop and maintain trusted relationships with internal partners and effectively work well in teams
Ability to manage ambiguity & problem solve
Prepare and submit appropriate expense reports in a timely fashion
Valid Driver’s License