Field Reimbursement Manager – Botox Therapeutic

Role Overview

• The Field Reimbursement Manager (FRM) shares expertise and educates on Medical and Pharmacy benefits, Buy & Bill and Specialty Pharmacy acquisition, payor policy, appropriate patient identification, clinical documentation, benefit investigation results, prior authorizations, billing, coding, patient tracking, claim submission, reconciliation management, patient financial savings programs, patient tracking/retreatment, and the denial/appeal process for the approved indications for BOTOX® Therapeutics.
• The FRM clarifies barriers that may impede or delay appropriate patient access to treatment and/or prevent optimal patient outcomes.
• The FRM may interact with healthcare providers, administrative staff, revenue cycle management, and institutional leadership.
• Educate on the fundamentals of the BOTOX treatment process, appropriate reimbursement, and understanding the payer landscape.
• Leverages advance problem-solving and analytical skills to identify access and reimbursement barriers while offering actionable insights to desired and approved care.
• Uncover the root cause to access issues impeding or delaying proper treatment.
• Monitor and provide updates on both Region and National Payers. Examples include changes or barriers in medical policy, Prior Authorization requirements, or product acquisition.
• Apply compliant methods to exchange critical information.
• Work collaboratively and function as a liaison for information between various internal stakeholders such as: Market Access, Center of Excellence, Sales, Marketing, Training, Compliance, Trade, and Specialty Pharmacy groups.
• Provide customer feedback relating to approval requirements and access to care barriers with AbbVie stakeholders (Market Access, Center of Excellence, Sales, Marketing, Trade, Specialty Pharmacy, Senior Leadership).
• Educate accounts on need-based tools to support patient access. Examples include HUB services, patient savings programs, payer coverage details, and acquisition pull-through initiatives.
• Proficient in providing analytical and customized need-based solutions to problems in complex environments and matrix influenced health systems and practices.
• Establish and maintain respectful working relationships with healthcare professionals and staff as well as business-oriented decision makers including C-Suite level executives within territory.
• Demonstrates the ability to lead without authority and effectively communicate with diverse groups with sometimes different priorities.
• Capable of influencing across functions to gain consensus on agreed upon patient solutions.
• Ability to professionally deliver crucial conversations that may contain less than desirable information or facts.
• Proactively engage in Field Input Teams offering innovative solutions to problems in a fast-paced changing environment.
• Share customer challenges and suggest potential solutions to address obstacles.
• Demonstrate effective planning, prioritization, follow up, and anticipates problems.

Requirements

• A minimum of 5–7 years of proven success in a health care related field
• Bachelor’s degree required
• Preferred experience includes Previous Sales, District Management, Hospital, Managed Markets, Access and Reimbursement, or practice experience
• Knowledge of Lean Six Sigma principles is favorable
• Exposure to physician-administered injectables, CPT and/or J-code reimbursement, Specialty Pharmacy and Buy & Bill acquisition, Benefit Verifications, Prior Authorizations, Claim Assistance, Appeals and payor policies, and HUB services
• Proven record of comprehensive work with accounts at all levels
• Payer/insurance coverage experience with Medicare, Medicare Advantage, Commercial and Medicaid plans
• Well-developed verbal and written communication skills, including in-person and virtual presentation skills of complex information and processes
• Proven and consistent competence of the following skills: Problem Solving, Gain Access, Resource Mastery, Tangible Results, Overcoming Adversity, Collaboration, and Managing Complexities
• Demonstration of key soft skills: Empathy, Critical Thinking, Curiosity, Persistence, Reliability, and Resourcefulness
• Strong history of leadership within current role
• Technology and analytical skills (Salesforce, virtual meetings, excel, report interpretation)
• A Valid Driver’s License
• Ability to travel adequately to cover territory, attend training, and meetings. Some overnight travel may be required.

Benefits

• paid time off (vacation, holidays, sick)
• medical/dental/vision insurance
• 401(k) to eligible employees
• long-term incentive programs