Hybrid Field Reimbursement Manager

Description

You are an expert facilitator: you open doors, foster communication, and bridge the gap.

The Virtual Field Reimbursement Manager (VFRM) will be responsible for the management of defined accounts in a specified geography.

The VFRM will execute a strategic plan through partnership with internal and external stakeholders, which may include call center services (HUB), sales, market access, and other collaboration partners.

In this role, the VFRM will serve as a reimbursement subject matter expert and will be responsible for providing office education during the entire process which may include formulary coverage/utilization management criteria, insurance forms & procedures, benefits investigation, prior authorization, appeal, and/or claims resolution.

Core Responsibilities include:

• Serves as the primary virtual reimbursement contact for assigned accounts, responding to reimbursement requests
• Serves as payer expert and be able to interpret and communicate payer changes, payer policies for Medicare, Medicaid and Commercial plans to key stakeholders in a timely manner
• Provides education and support to prescribing physicians and support staff regarding reimbursement, coding and patient access issues
  • Benefit verification results
  • Prior authorization requirements
  • Appeals processes
  • Claims submission and denial troubleshooting
  • Site of Care considerations (Buy and Bill)
  • CPT, HCPCS/J-codes, ICD-10, diagnosis of codes
• Assists with claims issue resolution, including underpayments, denials, and requests for additional documentation
• Tracks payer-specific challenges and communicate access or time-to-therapy trends, while triaging complex reimbursement or policy issues to appropriate internal partners for escalation when needed.
• Maintains detailed documentation of reimbursement cases, trends, and outcomes to identify recurring access barriers
• Manages multiple reimbursement cases simultaneously while meeting service-level expectations

Cross Functional Interaction:

• Coordinate virtually and in-person as needed with internal partners to:
  • Share payer insights and recurring reimbursement challenges
  • Support consistent messaging related to access pathways
• Provide clear, timely updates on case status and resolution outcomes using approved internal tools and processes
• Participate in internal meetings and trainings to stay aligned on reimbursement strategy and product updates

Along with demonstrated initiative, resourcefulness and a results-oriented mindset, the ideal candidate has:

• BA/BS degree required
• 5+ years of pharmaceutical &/or biotech experience
• 1+ years of experience in field reimbursement
• Ability to solve access issues related in specialty pharmacy channel
• Experience in oncology nice to have, not required
• Ability to travel 15% - 80% virtual and 15% live

At Syneos Health, we are dedicated to building a diverse, inclusive and authentic workplace. If your past experience doesn't align perfectly, we encourage you to apply anyway. At times, we will consider transferable skills from previous roles. We also encourage you to join our Talent Network to stay connected to additional career opportunities.

Why Syneos Health? Our ability to collaborate and problem-solve makes a difference in patients' lives daily. By joining one of our field access teams, you will partner with industry experts and be empowered to succeed with the support, resources, and autonomy needed to successfully navigate the complex reimbursement landscape. The diversification and breadth of our new and existing partnerships create a multitude of career paths and employment opportunities. Join our game-changing, global company dedicated to creating better, smarter, faster ways to get biopharmaceutical therapies to patients Experience the thrill of knowing that your everyday efforts are contributing to improving patients' lives around the world.

Work Here Matters Everywhere | How are you inspired to change lives?

Syneos Health companies are affirmative action/equal opportunity employers (Minorities/Females/Veterans/Disabled)

Syneos Health has a voluntary COVID-19 vaccination policy. We strongly encourage all employees to be fully vaccinated. Additionally, certain local governments or Syneos Health customers may have vaccine requirements that apply to some of our employees. These employees are required to submit proof of vaccination to Syneos Health and maintain compliance with these requirements.
At Syneos Health, we believe in providing an environment and culture in which Our People can thrive, develop and advance. We reward and recognize our people by providing valuable benefits and a quality-of-life balance. The benefits for this position will include a competitive compensation package, Health benefits to include Medical, Dental and Vision, Company match 401k, flexible paid time off (PTO) and sick time. Because certain states and municipalities have regulated paid sick time requirements, eligibility for paid sick time may vary depending on where you work. Syneos Health complies with all applicable federal, state, and municipal paid sick time requirements.

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