Field Reimbursement Manager - NJ
Company: Endo International plc
Posted on: May 15, 2022
The Field Reimbursement Manager (FRM) position is a critical
front line member of the Endo Access and Reimbursement Team. The
main driver of Endo Pharmaceuticals and Patient Access is patients
and assisting provider offices to help their patients get access to
care to get them back to living their best lives. The FRM role is a
field-based position whose job is to minimize access and
reimbursement barriers for patients and providers.
Within their geography, the FRM provides access and reimbursement
education to physician office personnel, billing staff/companies,
HCPs, as well as anyone involved in the process of utilizing the
product with the intention of minimize barriers and increasing
access to care. FRM education hones in on Endo Specialty therapies,
how to buy and bill our products, acquire through specialty
pharmacies and educate on office processes. FRMs also support
provider offices on a reactive basis by providing education and
guidance in response to PA denials and claim denials and/or
underpayments. The FRM will leverage all data analytic tools to
minimize delay in receiving treatment by working with internal and
Subject matter expert for all reimbursement/access 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. This includes: payer
policies, prior authorization requirements, denial and appeal
process, peer to peer, and other education required to navigate
access for the appropriate patients.
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:
Managing patient assistance and reimbursement support services
offered to providers and related to patient access to buy/bill
Coordinating with Endo's patient support services program
Educating office staff on the use of Buy/Bill products, patient
assistance and reimbursement support services.
Participating in sales training related to product
Utilizing data to critically think through acquisition challenges
from a variety of outlets including SP, Specialty Distributors and
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.
Act in a compliant manner at all times.
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 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
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.
Develop short and long term account plans for key accounts with the
goal of smoothing out the process of acquiring drug to optimize
acquisition and patient journey
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
Identify in conjunction with the field, specific targeted accounts
where the FRM will assist with product acquisition or SP
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
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.
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.
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 all supported
specialty products. Ensure alignment with ASM and District
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.
BS or equivalent is required; MBA or advanced degree preferred.
5-7 years of relevant experience in the Biopharma industry
Three years' experience in 3rd party reimbursement and managed care
Significant experience in patient access support, i.e., copay
programs, HUB management, payer experience, etc.
Superb knowledge and operationalizing experience of buy & bill and
Previous experience working with vendor relationships
Previous experience managing customer interactions required.
Previous sales management and/or account management experience
All newly hired FRMs should enter at this level regardless of their
tenure or experience elsewhere.
Systemic understanding of the global payer and distribution
environment, in particular, physician administered biologics in the
Understanding of coverage, coding (diagnostic, procedural and
product), payment and reimbursement requirements and policies.
Knowledge/expertise in commercial payer policy.
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,
Significant sales experience in the biologic (injectable)
Possess a strong understanding of commercial payers, Medicare Part
B and D and Medicaid; particularly in assigned geography.
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.
Leverage all resources (Tableau and other portals) to develop and
execute account support and educate sales colleagues.
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.
Superior verbal, written, and presentation skills to effectively
convey strategic and technical market access information, with an
ability to condense complex information into concise outputs and
Ability to balance external stakeholders' wants with Endo
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.
Model Endo's vision and core values and encourages others to foster
a culture of compliance
Conduct business at the c-suite level for large hospital systems
and can address more routine policy and State Medicaid and Medicare
Significant travel involved.
Keywords: Endo International plc, Trenton , Field Reimbursement Manager - NJ, Executive , Trenton, New Jersey
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