Field Reimbursement Manager Tzield- Northeast Region
The individual in this role will need to demonstrate a deep passion for patients and caregivers with an emphasis on enhancing and optimizing the patient and prescriber experience with our support program offerings. Moreover, since this is a foundational role, this individual will need to quickly establish compliant relationships with patients and providers, helping to ensure successful access to the prescribed treatment. Lastly, to be successful in this role, strong and compliant cross-functional collaboration with Sales and other commercial team members is essential.
The Tzield reimbursement environment is highly challenging for Health Care Providers (HCPs) and Patients. Payer medical and pharmacy Utilization Management (UM) criteria create process delays for patients like required Benefits Investigations (BI), Prior Authorization (PA), Denial Appeals, detailed Clinical Documentation, and Peer to Peer reviews. Assisting HCPs and Patients to gain access to prescribed treatments requires dedicated and knowledgeable customer facing support.
Field Reimbursement Manager/Director for TZIELD. This is a regionally aligned, field-based position that provides reimbursement education and support for customers that utilize TZIELD (and other future products). You will act at the subject matter export on access, reimbursement, billing and coding processes and providing support through (1) product-specific provider reimbursement support, (2) coordination of HUB/Patients Services reimbursement services, and (3) managing payer/coverage pull-through initiatives.
Key responsibilities for a TZIELD FRM within Gen Meds will be:
Work closely with patients/caregivers and providers to gain access to therapy
Be the single point of contact for patients, caregivers, and providers in the assigned region
Back-up colleagues and collaborate across patient services team
Successfully and compliantly enroll patients into the program
Perform Benefit Verifications, Prior Authorization follow-up, and Appeal follow-up
Counsel patient/family on reimbursement options and financial assistance options
Manage general inquiries via phone or email
Work with specialty pharmacies and specialty distributors
Coordinate with different sites of care, including infusion centers
Manage the transition from infusion site to in-home infusion therapy as appropriate
Maintain case history for all assigned patients in the CRM system
Troubleshoot and resolve ongoing reimbursement issues (insurance changes, PAs, other)
Record and report Adverse Events and Product Complaints
Manage replacement requests from HCPs
Perform data entry, answer and make outbound calls, utilize email, fax and SMS to correspond with patients and HCPs as appropriate
Proactively communicate specific patient support offerings, utilizing MLR-approved materials
Schedule time with HCPs in the field or over Zoom to educate and/or work through reimbursement challenges
Educate HCPs and staff on product procurement through SP or Buy/Bill, site of care, and billing/coding
Inform HCPs and office staff of approved billing and reimbursement information using MLR-approved items (J-codes, EOBs, co-pay programs, etc.)
Provide HCPs with compliant information and coverage guidance to help address coverage and reimbursement matters
Stay educated about compliance and OIG guidance and policies regarding patient support programs and offerings
Attend patient meetings and represent Provention Bio at industry conferences
Travel to national meetings and medical offices as needed
Establish and maintain knowledge on the local and national payer landscape, including Specialty Pharmacy and Utilization Management criteria for TZIELD
Reactively address access and reimbursement issues and provide necessary education for them to secure appropriate reimbursement and access
Provide PRC approved information related to product coverage, which may include payer specific requirements for claims processing, information regarding prior authorizations and the appeals process, as well as general information regarding disease state
Interact regularly with Tzield Sales Force (KAMs), Case Mangers, Regional Account Directors to provide field intelligence and disseminate payer policy and positive advantage
Coordinate with field sales regarding prioritization of accounts to ensure targeted, timely lists of key accounts. Ensure ongoing communication with field sales regarding account follow-up plans.
Serve as a primary point of contact for Market Access team for distribution of information and payer issues
Work & coordinate with the HUB/Patient Services Director to educate customers on appropriate available patient support programs. Explain financial assistance and other funding options available for TZIELD patients Help the practice understand how to enroll patients in appropriate programs. Advocate for TZIELD HUB utilization for patient-specific access support needs.
BA/BS Degree required, preferably in life science or business, MBA a plus
Minimum 5-7 years of prior field-based reimbursement and access Oncology, CVGHD experience required
Minimum 10 years of other related pharma/biotech experience strongly preferred (e.g., Market Access, Sales, Product Marketing)
Comprehensive understanding of pharmacy benefit policies across payer types (Medicare, Medicaid, commercial, VA/DoD, etc.) and sites of care (Community Oncology, Academic Medical Center Practices etc.)
Ability to lead without authority within cross-functional groups and in a matrix organization
Exceptional professional communications and interpersonal/problem-solving skills necessary to interact with key decision makers (CFO and other c-suite level stakeholders)
Demonstrated ability to identify key access barriers and design effective resolution plans
Ensures compliance with all corporate and industry policies in collaboration with Legal, Regulatory and Compliance Qualifications
Desire to innovate and work in a fast-paced, energetic environment
Must achieve and maintain compliance with all applicable Sanofi compliance policies, procedures, and legal requirements.
Excellent strategic thinking, analytical, and communication skills required
Valid driver's license
Must achieve and maintain compliance with all applicable Sanofi Genzyme compliance policies, procedures, and legal requirements.
~50%-75% Travel, depending on geography
Candidates must live near a major airport
Ability to travel to meetings/trainings/programs as necessary - additional travel will be required within the assigned geography.
Sanofi Inc. and its U.S. affiliates are Equal Opportunity and Affirmative Action employers committed to a culturally diverse workforce. All qualified applicants will receive consideration for employment without regard to race; color; creed; religion; national origin; age; ancestry; nationality; marital, domestic partnership or civil union status; sex, gender, gender identity or expression; affectional or sexual orientation; disability; veteran or military status or liability for military status; domestic violence victim status; atypical cellular or blood trait; genetic information (including the refusal to submit to genetic testing) or any other characteristic protected by law.
Candidates must complete all fleet safety training and must maintain an acceptable driving record regarding accidents and incidents.
At Sanofi diversity and inclusion is foundational to how we operate and embedded in our Core Values. We recognize to truly tap into the richness diversity brings we must lead with inclusion and have a workplace where those differences can thrive and be leveraged to empower the lives of our colleagues, patients and customers. We respect and celebrate the diversity of our people, their backgrounds and experiences and provide equal opportunity for all.
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