Known for its scientific and operational excellence, Regeneron is a leading science-based biopharmaceutical company that discovers, invents, develops, manufactures, and commercializes medicines for the treatment of serious medical conditions. Regeneron commercializes medicines for eye diseases, high LDL-cholesterol, atopic dermatitis and a rare inflammatory condition and has product candidates in development in other areas of high unmet medical need, including rheumatoid arthritis, asthma, pain, cancer and infectious diseases.
Summary:The Reimbursement Business Manager, Oncology reports to the Director, Field Access & Reimbursement. This position is a critical front-line member of the Regeneron Field Access & Reimbursement team. The primary purpose of this role is to support medical oncology offices in obtaining appropriate reimbursement and to support the company and divisional reimbursement strategy for Regeneron products within various payer segments.
Work cross-functionally and collaboratively with sales organization (Reimbursement Directors and Oncology Medical Specialists) to act as Reimbursement/Payer Subject Matter Expert, in efforts to support the healthcare provider segment.
Provide reimbursement support services/activities in concert with RDs/MSs (field sales), to educate physician offices in coverage, coding and reimbursement of Regeneron products, in efforts to streamline reimbursement processes and outcomes.
Establish relationships within targeted healthcare provider offices to assist healthcare professionals in resolving reimbursement issues that may be barriers to product access in a manner that complies with Regeneron policies, processes, and standard operating procedures.
Assist healthcare providers in identifying claims, coding issues and process changes to provide guidance on claims appeal processes within provider offices.
Individual must be acutely aware of reimbursement requirements and environmental changes to coverage policies set forth by government, federal and managed care organizations.
Individual must be flexible to anticipate and adapt to customer reimbursement and support needs, as well as market changes and challenges.
Ability to build foundational relationships within payer segments to ensure appropriate product education and overall product support.
Ability to identify payer trends through payer, provider and field collaboration.
Responsible for submitting individual development goals, territory business plan, monthly activity reports, expense reports and other reports as requested by the Director, National Account & Strategy.
Complete assignments projects as directed and in a timely manner.
Demonstrate appropriate territory planning and time management skills by effectively covering the specific geographical area of responsibility.
Meet or exceed the standard level of performance in target account activity.
Provide sales support via distribution of reimbursement materials and assistance to physician offices and Medical Specialists. Work with Director of Reimbursement Services to track and report on trends within territory assist hotline staff in addressing coding, coverage or reimbursement resolutions, appeals for authorization and payment as directed. Constantly evaluate levels of customer support delivered and work with department personnel toward improving customer support.
Work collaboratively within the various Regeneron departments to facilitate, implement and execute the overall divisional and corporate goals and objectives.
Bachelor's degree from a four-year college or university.
8-10 year's pharmaceutical/biotech/device industry experience including 3-5 years healthcare coverage, coding and/or reimbursement experience with device, pharmaceutical, and/or biotechnology company.
Must have previous experience working with billing and medical claims personnel in various health care settings, including, but not limited to a physician office, hospital, hospital out-patient and ambulatory surgery centers. Oncology experienced preferred.
Must have proven expertise in supporting healthcare provider offices with medical coding, claims/billing processes and submissions of both public and private insurers for biotechnology, medical devices and/or pharmaceutical products.
Familiarity with appropriate coding terminology and processes CPT, HCPCS, ICD-10, revenue codes and DRG, coverage and reimbursement.
Must have familiarity with health insurance claim forms including UB-04, CMS-1500, explanation of benefits, and prior authorization forms, and super bills charge tickets to troubleshoot cases where billing, claims submission or documentation errors may occur, as support and guidance may be required to HCP's.
Ability to analyze, interpret and understand regulatory and legislative payer and healthcare policies.
Knowledge of private payer (MCO), Medicare, and Medicaid structures, systems, methodology, and reimbursement policies and processes
Travel: ~70% field travel required
Must be based in, or located in close proximity to, Phoenix/Tucson, AZ (relocation will not be provided)
Ability to travel in Southwest Territory (Phoenix/Tucson, Las Vegas/Inland Empire)
This is an opportunity to join our select team that is already leading the way in the Pharmaceutical/Biotech industry. Apply today and learn more about Regeneron's unwavering commitment to combining good science & good business.
To all agencies: Please, no phone calls or emails to any employee of Regeneron about this opening. All resumes submitted by search firms/employment agencies to any employee at Regeneron via-email, the internet or in any form and/or method will be deemed the sole property of Regeneron, unless such search firms/employment agencies were engaged by Regeneron for this position and a valid agreement with Regeneron is in place. In the event a candidate who was submitted outside of the Regeneron agency engagement process is hired, no fee or payment of any kind will be paid.
Regeneron is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability status, protected veteran status, or any other characteristic protected by law.