Field Reimbursement Manager, Immunology (Western US)

Sobi is seeking a highly experienced passionate Field Reimbursement Manager.  Reporting to the Director of Field Reimbursement in the Immunology Franchise the Field Reimbursement Manager (FRM) is an important member of the Sobi Market Access team.

The FRM role is a field-based non-promotional resource for infusion centers health systems institutions hospitals and HCP practices/groups that serves as the key to help unlock patient access and resolve reimbursement issues.  The successful candidate brings strong knowledge and proven work history of access and reimbursement for buy-and-bill/infused pharmaceutical products. The FRM in addition to working closely with external customers will work with numerous internal teams including Patient Services Market Access colleagues Medical Affairs Advocacy and Marketing to facilitate and support patient access to treatment.  The FRM is a critical component of customer support and will rely on strong problem-solving skills to provide outstanding customer experiences and outcomes.  

The successful candidate will accomplish this by: 

• Customer Engagement: As a field reimbursement manager the FRM is expected to maintain a targeted account list of customers and proactively engage accounts live and virtually.  

• Proactively and consistently working with assigned customers to educate on access and reimbursement as well as build and maintain relationships with all relevant departments and personnel including but not limited to Infusion Center Manager Biologic Coordinators Reimbursement Specialist/Coordinator Patient Access Specialist Financial Counselors Billing and Coding Specialists Nurse Navigator Pharmacists Revenue Cycle Manager Patient Advocates and prior authorization specialists.    

• Acting as the subject matter expert with a deep level of understanding of buy and bill reimbursement and access & reimbursement across all channels (Commercial Medicare Medicaid Government) who educates and identifies compliant solutions to overcome patient access and reimbursement issues.  

• Providing proactive education to prescribers and sites of care upon patient enrollment on coverage for Sobi therapies common prior authorization requirements and coding and billings requirements. 

• Providing comprehensive education to healthcare providers and their staff on reimbursement procedures coding billing and documentation practices specific to biologic therapies. 

• Educating infusion centers HCP offices health systems institutions and hospitals in understanding the mechanics of patient benefit verification product ordering through Specialty Pharmacy Specialty Distribution. 

• Demonstrated ability to investigate access challenges pre and post-infusion for Sobi products 

• Assist healthcare providers in understanding and managing reimbursement processes for buy-and-bill infused biologic products. This includes offering compliant support on prior authorizations appeals and denials.  

• Assisting infusion centers HCP offices health systems institutions and hospitals in understanding billing & coding; specifically CPT coding J-Codes and modifiers as well as use of CMS 1500 and UB-04 forms. 

• Acting as a bridge between the customer the patient services team and Sobi sales and account management team to address access escalations and payer access issues.

• Working closely with the HUB and the Case Managers to compliantly address escalations and access issues for HUB patients.

• Working with local Sobi colleagues with a high level of cross-functional support for accounts in a defined geography.

• Additional responsibilities include developing local solutions through account and market insight and providing Sobi leadership with market intelligence.  This role inspires solution-oriented passion across cross-functional teams. 

Qualifications :

1. Demonstrates deep knowledge in: 

Reimbursement experience supporting infused product Buy and Bill 

Reimbursement and access across all channels (Commercial Medicare Medicaid Exchange and Government) and is the subject matter expert of the payers in the markets they will support 

All phases of specialty distribution specialty pharmacy core services to assist with supporting access and product procurement 

Healthcare structures payment systems and reimbursement methodology 

2. Works compliantly and collaboratively with internal and external business partners to winThinks and acts as a team; understands the nature and interdependencies of a matrix team environment and can effectively work cross-functionally to seize opportunities resolve payer issues improve customer experience avoid bureaucracy and maximize outcomes of strategies and key actions. 

Internal Partners: Sales Marketing Patient Services (case managers nurse support) Trade Team National and Regional Account Directors Medical Affairs  

External Partners: Builds relationships with: Infusion Centers Health Systems Institutions Hospitals HCPs practice managers reimbursement/access departments and other customers who support access & reimbursement  

3. Exhibits strong problem-solving skills related to complex patient access challenges across payers and specialty pharmacies 

4. Ability to educates health systems institutions hospitals and HCP office staff about: 

Patient Service Program options to optimize patient access to Sobis products 

Prior authorization requirements coverage status and payer appeals requirements processes and timelines 

Billing and Coding 

5. Comprehends and effectively demonstrates ability to compliantly conduct field-based customer support related to payer coverage and payment process (coverage navigation & specialty pharmacy fulfilment)  

6. Adheres to all relevant pharmaceutical industry regulations (including but not limited to FDA rules and PhRMA Code) and Sobi Ethics & Compliance policies and demonstrates a willingness to coach to ensure a culture of compliance 

Education and Experience:

A minimum of a B.A/B.S. required 

A minimum five (5) years of reimbursement work experience in Pharmaceuticals/Biotech/Medical Device with relevant understanding of the following areas: 

Patient journey navigation 

Payer coverage polices 

Medical & Pharmacy benefit reimbursement 

Specialty pharmacy and distribution 

In office dispensing accounts 

Hub and Patient Services 

Preference will be given to candidates with the following experience: 

Buy and Bill and infusion reimbursement experience  

Launch reimbursement experience 

Strong understanding of the Gout disease state and treatment options 

Demonstrated ability to work targeted accounts; specifically working to identify engage and build relationships with key reimbursement contacts access personnel and practice managers within identified accounts.  

Industry Knowledge proficient understanding of the pharmaceutical industry disease state and drug distribution process (e.g. medical specialty pharmacy managed care systems etc.) 

Understanding of Commercial Medicare and Medicaid drug coverage and current and pending changes to drug coverage benefits 

Technical Expertise (Reimbursement and Patient Access) in the buy and bill space: Reimbursement and patient access knowledge with the ability to effectively convey knowledge to key stakeholders. 

Skills and Competencies: 

Computer Skills Ability to effectively use technology to support escalation work internal and external portals and databases 

Advanced Microsoft Excel skills that support analysis of large databases and manage a high volume of data 

Analytical Skills Ability to analyze and leverage data/reports to identify trends and opportunities 

Demonstrates Passion high energy excitement and a sense of urgency toward organizational purpose and values. 

Cultivates High IMPACT Partnerships with internal and external partnersDevelops meaningful partnerships based on Sobi Core Values striving to earn and preserve the trust respect and admiration of all stakeholders. 

Values & Unlocks CollaborationCultivates an atmosphere of collaboration and reciprocal communication that creates an environment that inspires all to demand the best from themselves 

Business SavvyDemonstrates a clear understanding of the current territory business situation marketplace and environment.  

Understanding and application of HIPAA rules and regulations related to patient privacy 

Strong written and verbal communications as well as presentation skills 

Additional Comments:

Estimated travel 50%

Additional Information :

Compensation and Total Rewards at Sobi

At Sobi we are dedicated to providing our employees with a comprehensive and industry-competitive total rewards package. Our compensation philosophy is designed to recognize and reward talent ensuring that your contributions are valued and reflected in your overall rewards.

Your total compensation at Sobi goes beyond just your base salary and annual bonus. It also includes a robust suite of benefits such as:

• A competitive 401(k) match to support your financial future.
• Tuition and wellness reimbursements to invest in your personal and professional growth.
• A comprehensive medical dental and vision package to prioritize your health and well-being.
• Additional recognition awards to celebrate your achievements.

The base salary range for this role is . Each individual offer will be determined based on several factors including your experience qualifications and location. Additionally this role is eligible for both short-term and long-term bonuses as outlined in the plan details.

All Sobi employees need to demonstrate behaviors in line with Sobis core values: Care Ambition Urgency Ownership and Partnership. Are you ready to be on the Sobi team Come join a culture that empowers every person to be the person that makes a difference for rare disease.

Why Join Us

We are a global company with over 1900 employees in more than 30 countries and are committed to the societies where we operate. With a deeply skilled management team directing our day-to-day wins and a Board with a stellar track record were ready to take on the worlds diseases ailments and adversity. Our people believe they have the power to make a positive impact in others lives because thats exactly what we do here. If youre seeking a career that taps into your talents in a way that makes the world a better healthier place we just may have a job for you.

We know our employees are our most valuable asset and our culture conveys that. We offer a competitive benefits package to support the health and happiness of our staff.

Sobi Culture

At Sobi we refuse to accept the status quo. This is because we have witnessed first-hand the challenges facing those affected by rare diseases and have used this knowledge to shape our business to find new ways of helping them.

As a specialized biopharmaceutical company we are dedicated to rare diseases. And we see this focus as a strength. By effectively turning our research into ground-breaking treatments we help make medicine more accessible and open up more possibilities for patients and more opportunities for those caring for them. This has been our approach since day one but we know we cant change the world of rare diseases on our own. Accomplishing this requires strong partnerships with patients partners and stakeholders across the entire value chain. Together we define how our business can create solutions that serve the needs of those affected by rare diseases while facilitating sustainable growth.

An Equal Opportunity Employer

Sobi is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. All employment decisions at Sobi are based on business needs job requirements and individual qualifications without regard to race color religion or belief national social or ethnic origin sex (including pregnancy) age physical mental or sensory disability HIV Status sexual orientation gender identity protected veterans and/or expression marital civil union or domestic partnership status past or present military service family medical history or genetic information family or parental status or any other status or protected groups by the laws or regulations in the locations where we operate.

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Remote Work :

Yes

Employment Type :

Full-time