Portfolio Manager managing transactions and business portfolios for Fifth Third Bank. Assessing credit viability and collaborating with clients and stakeholders in a financial setting.
About the role
- Field Reimbursement Manager educating healthcare providers on product-specific prior authorization and appeals processes. Field-based role within men’s health and collaborative teams.
Responsibilities
- Educate HCPs and appropriate office staff about product specific prior authorization & appeals process, how to access related forms, and high-level information about submission procedures and reauthorization requirements.
- Work with in-network Specialty Pharmacies on cases where the patient has provided consent.
- Educate HCPs and appropriate office staff on specific referral processes and patient assistance programs.
- Work closely with sales and other matrix partners to identify additional accounts with need for education.
- Utilize approved resources and FAQs to provide education and answer questions as needed.
- Solid understanding of reimbursement issues that work within our core classes of trade: Commercial Managed Care (Regional Plans) Medicaid (Fee for Service, Managed Care Organizations) Medicare (Part A, B, C, D; Carriers) Veteran’s Administration (VISNs) TRICARE Regional Offices Specialty Pharmacy & Pharmacy Benefit Managers ACOs and other Integrated Delivery Networks (IDNs) Advocacy, consumer, provider and treatment systems groups.
- Document interaction details within CRM with attention to data integrity to ensure compliance with program policies and business rules.
- Maintain confidentiality of Patient Health Information (PHI) and act in compliance with all laws, regulations, and company policies.
- Adhere to all Inizio and client policies, procedures, business rules, and call guides, as well as applicable laws.
Requirements
- BS/BA required.
- 3+ years of relevant experience in – reimbursement and patient access, market access, specialty pharmacy, or physician/system account management.
- Proven success operation in a field-based role
- Experience in endocrine or men’s health disorders preferred.
- Strong knowledge and understanding of payer reimbursement models (medical and pharmacy), prior authorization and appeal requirements, coding changes, appropriate claim submission, integration of HUB and patient assistance programs
- Maintains compliance with program business rules, standard operating procedures and guidelines
- Highly organized with excellent attention to detail and the ability to multi-task in engaging both patients and providers.
- Passionate about learning and able to share/communicate that passion to others.
- Experience engaging HCP staff in a support role to educate on access pathways and product requirements.
- Experience navigating payer reimbursement process, preferably Medicare Part D (pharmacy benefit design and coverage policy).
Benefits
- Competitive compensation
- Excellent Benefits – accrued time off, medical, dental, vision, 401k, disability & life insurance, paid maternity and paternity leave benefits, employee discounts/promotions
- Employee discounts & exclusive promotions
- Recognition programs, contests, and company-wide awards
- Exceptional, collaborative culture
- Best Places to Work in BioPharma (2022, 2023, & 2024)
- Certified Great Place to Work (2022, 2023, 2025)
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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