Field Reimbursement Manager FRM) West

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.