Field Reimbursement Manager FRM) Great Lakes

The Field Reimbursement Manager (FRM) is a regionally aligned, field-based position that provides reimbursement education and support for customers that utilize Omidria® and future Rayner products.

Customers may include Healthcare Providers (HCPs), ambulatory surgery centers (ASCs), hospital outpatient departments (HOPDs), and other appropriate site-of-care facilities. The FRM will work closely with internal/external business partners including HCPs, billing/coding/revenue cycle staff and other professionals involved in securing appropriate Reimbursement for the use of Omidria®.

Core and role specific competencies

•  The FRM is responsible for strategically aligning strategies to support Rayner organizational goals by minimizing barriers and optimizing reimbursement to Rayner Ophthalmology portfolio.
• The FRM provides support through: (1) product-specific provider reimbursement support; (2) coordination of HUB reimbursement services; and (3) Communication of payer policy changes that impact reimbursement.
• The FRM will serve as a subject matter expert regarding education and insights on the reimbursement of Omidria across multiple payer types and plans (i.e., Medicare, Medicaid, Medicare Care Advantage, Commercial, and Government).
• The FRM will provide education and support the integration of account implementation strategies for Omidria and future Rayner products within accounts (ASC/HOPD/IDN/Academic/340b Institutions) aligning billing and coding practices with payer and account contractual requirements.
• Reactively address reimbursement barriers by analyzing business issues/opportunities and executing sound business solutions to secure reimbursement.
• The FRM must have a strong working knowledge of separately paid J-codes in a buy-and-bill environment.
• Function as the HUB liaison with demonstrated expertise on navigating financial assistance programs
• Monitors reimbursement trends and maintains expertise in national, regional, local, and account market dynamics including coverage, coding requirements, payer healthcare policies, and impact of legislative changes.
• Demonstrated teamwork and strong interpersonal and cross-functional collaboration abilities with high emotional intelligence skills to interface effectively in managing multiple business initiatives and cross-functional relationships.
• Build and maintain strong, trust-based relationships with external stakeholders across all Rayner accounts.
• Execute business in accordance with the highest ethical, legal, and compliance standards, including timely and successful completion of all required training.
• Ability to interpret and maintain a deep understanding of all Rayner and industry legal, regulatory, and compliance policies and requirements consistent with company guidance.

Qualifications/ Training/Experience

• Bachelor’s Degree required.
• Minimum 10 years of diverse expertise within the biopharmaceutical or medical device industry (to include but not limited to sales, sales management, training, marketing, market access, etc.
• Minimum of 3 years reimbursement/access/healthcare policy experience
• Ability to navigate challenging access barriers and execute strategies in a timely and efficient manner.
• Superior communication skills (written and verbal) and efficient follow-through.
• Experience working within the “buy and bill” environment including coding, coverage, and reimbursement.
• Advanced knowledge of medical insurance terminology, CPT, HCPCS, ICD-10, and revenue and J codes.
• Knowledge of UB-04, CMS-1450, CMS-1500, and EOBs.
• Extensive knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes, with expertise in Medicare Part B (Medical Benefit design and coverage policy), and National payers.
• Reimbursement experience within various sites of care, such as ASCs/HOPDs. Additional experience with Integrated Delivery Network/Integrated Health Systems/Academic Institutions/340b designated institutions is a plus.
• Experience in working with patient support HUB services.
• Ability to travel and cover large multistate geographic territories; 25%- 50% travel required.
• Valid US driver’s license and a driving record in compliance with company standards.

What you can expect from us: 

• Comprehensive benefits package
• Global appreciation platform to recognise colleagues around the globe
• Fantastic opportunity to work with highly talents teams and individuals and grow with the business
• Exciting variety of engagement events like yoga, seat chair massages, Summerfest, quarterly Love to Learn events
• Being part of an organisation you can be proud to work for changing the lives of millions of people!

Rayner provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.