Job Description
Medexus is a leading specialty pharmaceutical company with a strong North American commercial platform and a growing portfolio of innovative and rare disease treatment solutions. Medexus current focus is on the therapeutic areas of hematology, oncology, auto-immune diseases, and allergy.
Position Overview The Field Reimbursement Manager (FRM) will play a critical role in supporting patients, healthcare providers, and the sales team for Medexuss rare disease hematology oncology product. Responsibilities include educating oncology hospital and transplant center claims and billing administrators on treosulfan coding, reimbursement support services, payer reimbursement and medical policies. Additionally, the FRM will help resolve patient-specific reimbursement, coding, precertification, and appeals issues related to treosulfan as a HIPAA compliant business associate. The FRM is a critical front-line member of the Medexus organization and will work across multiple internal stakeholders including Sales, Marketing, Market Access, Trade, and Reimbursement Support Hotline to deliver an exceptional customer experience.
Position Responsibilities - Provide reimbursement support for Treosulfan to claims and billing administrators within targeted oncology hospitals and transplant centers.
- Help resolve patient-specific reimbursement, coding, precertification, and appeals issues related to Treosulfan.
- Educate hospital and transplant center staff on Treosulfan coding, reimbursement support services, payer reimbursement and medical policies.
- Collaborate with key stakeholders including hospital/transplant center claims administrators, Treosulfan reimbursement hotline personnel and provider service representatives of payers to help resolve reimbursement issues.
- Support field in education of hospital/transplant center personnel on precertification and appeals processes and reimbursement support through the Treosulfan Reimbursement Support Hotline.
- Work with key stakeholders to ensure treosulfan it correctly loaded within the hospital chargemaster system.
- Develop and implement business plans to support appropriate access to Treosulfan within targeted oncology hospitals and transplant centers.
- Establish and maintain knowledge of the local and national payer landscape for Treosulfan including medical policies and utilization management criteria.
- Establish and maintain knowledge of the specialty distribution landscape for Treosulfan and help to resolve any issues that hospitals and transplant centers are having with ordering and receiving Treosulfan.
- Executes all activities within defined regulatory and compliance standards.
- Achieve and maintain compliance with all applicable Medexus Pharma policies and procedures, regulatory and legal requirements, and help to monitor compliance during cross functional team interactions.
Education, Experience & Skill Requirements - Bachelor's degree in business, healthcare, life sciences, or a related field required; advanced degree preferred.
- Coding certification such as Certified Professional Coder (CPC), Certified Coding Specialist (CCS) or Certified Medical Coder (CMC) strongly desired.
- Minimum 7+ years of experience in the pharmaceutical/healthcare industry
- Must have 2 years in a reimbursement role supporting hospitals and clinics with medical coding, claims/billing processes and submissions to both private and government insurers for pharmaceutical products.
- Must have experience working with a pharmaceutical product that is used inpatient and reimbursed under a DRG or Case Rate.
- Must have experience working with a pharmaceutical product that is used outpatient and reimbursed as a medical benefit.
- Must have expertise with Medicare and private insurance billing/claim forms including UB-04, 837-I, CMS-1500, 837-P, and EOB and billing codes including DRGs, Case Rates HCPCS codes and J-Codes.
- Must have strong interpersonal skills including managing and resolving conflict and building strong working relationships.
Additional Information - Must be willing to travel up to 70%/3 days per week (This role will support approximately 1/2 of the country and require extensive air travel).
- Salary Range: $165,000 - $185,000
- Must live near a major airport hub. Preferred locations:
- East: New York City/Newark, Boston, Atlanta, Chicago
- West: Los Angeles, San Francisco, Denver, Phoenix, Dallas, Houston
Medexus Pharma is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age, disability or any other characteristic protected by law. We assure you that your opportunity for employment with Medexus Pharma depends solely on your qualifications. We value diversity and the existence of similarities and differences, both visible and not, found in our workforce, workplace and throughout the markets we serve. Our employees, customers and shareholders contribute unique and different perspectives as a result of these diverse attributes. We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform crucial job functions, and to receive other benefits and privileges of employment. Please contact us at careers@medexus.com to request accommodation.
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