Field Reimbursement Manager (FRM) - Rockies
Otsuka Pharmaceutical Companies (U.S.)
Summary
The Field Reimbursement Manager (FRM) serves as the subject-matter expert on reimbursement, access, and coverage issues for our products, primarily focusing on Nephrology and potentially other therapeutic areas. This role operates as a crucial liaison between healthcare providers (HCPs), internal teams, and external stakeholders to facilitate appropriate patient access to our products.
Job description
Position Summary
The Field Reimbursement Manager (FRM) serves as the subject-matter expert on reimbursement, access, and coverage issues for our products, primarily focusing on Nephrology and potentially other therapeutic areas. This role operates as a crucial liaison between healthcare providers (HCPs), internal teams, and external stakeholders to facilitate appropriate patient access to our products.
Key Responsibilities
- Educate HCPs and their staff on matters related to access, coverage, reimbursement processes, claims submissions, and coding requirements
- Analyze payer criteria and provide product access expertise to healthcare offices
- Coordinate with Hubs on individual patient cases, including patient support services and enrollment
- Collaborate with Field Sales, Specialty Pharmacy Accounts, and other matrix partners
- Manage daily field-based activities, spending 60-70% of time interacting with key stakeholders across various care sites
- Execute collaborative territory plans through partnerships with internal and external stakeholders
- Review and educate offices on payer policies, including prior authorization requirements
- Provide feedback to internal teams on local payer trends and access issues
- Assist in resolving patient-specific coverage challenges when requested by healthcare providers
Qualifications
- Bachelor's degree required
- Minimum 5 years of pharmaceutical industry experience, with focus on payer policy and reimbursement is preferred
- At least 3 years of experience in benefit verifications, prior-authorization requirements, or equivalent experience in patient access, billing, and coding in rare disease is preferred
- Strong knowledge of Centers for Medicare & Medicaid Services (CMS) policies and processes, especially Medicare Part D
- Experience in "Buy and Bill" reimbursement environment
- Nephrology experience strongly preferred
- Comprehensive understanding of US healthcare system payer billing practices
- Proficiency in MS Office suite
Skills and Abilities
- Excellent verbal and written communication skills
- Strong interpersonal and consultative abilities
- Self-directed with outstanding organizational skills
- Ability to build and maintain strong relationships with internal and external customers
- Proficient in delivering training and presentations
Travel Requirements
- Ability to travel up to 60-70% domestically
- Valid driver's license required
Requirements
- Bachelor's degree required
- Minimum 5 years of pharmaceutical industry experience
- At least 3 years of experience in benefit verifications, prior-authorization requirements, or equivalent experience in patient access, billing, and coding in rare disease
- Strong knowledge of CMS policies and processes, especially Medicare Part D
- Experience in "Buy and Bill" reimbursement environment
- Comprehensive understanding of US healthcare system payer billing practices
- Proficiency in MS Office suite
- Excellent verbal and written communication skills
- Strong interpersonal and consultative abilities
- Self-directed with outstanding organizational skills
- Ability to build and maintain strong relationships with internal and external customers
- Proficient in delivering training and presentations
- Ability to travel up to 60-70% domestically
- Valid driver's license required
Benefits
- Medical, Dental & Vision
- Prescription Drug Coverage
- Basic Life Insurance
- AD&D Insurance
- Short & Long-Term Disability
- Tuition Reimbursement
- Student Loan Assistance
- 401(k) Matching
- Flexible Time Off
- Paid Holidays
- Paid Leave Programs
Company overview
Otsuka Pharmaceutical Companies (U.S.) represents the American operations of the global Otsuka pharmaceutical group, comprising two main entities: Otsuka America Pharmaceutical, Inc. (OAPI) and Otsuka Pharmaceutical Development & Commercialization, Inc. (OPDC). OAPI focuses on commercializing Otsuka-discovered and in-licensed pharmaceutical products in North America, while OPDC handles clinical development and global registration of innovative healthcare products. Headquartered in Princeton, New Jersey, with additional facilities in Rockville, Maryland and Hayward, California, the company employs 1,001-5,000 professionals dedicated to advancing treatments in neuroscience and nephrology. Otsuka has established a strong legacy in the U.S. market since establishing its first research base in 1985, with notable achievements including the development and commercialization of blockbuster medications such as ABILIFY (aripiprazole) for psychiatric disorders and JYNARQUE (tolvaptan) for polycystic kidney disease. The company maintains a robust pipeline focused on central nervous system disorders, nephrology, immunology, and metabolic diseases, driven by its mission of 'creating new products for better health worldwide.'