Mar 22, 2024

Field Reimbursement Manager (FRM) - North Texas

  • Professional Diversity Network
  • San Francisco, CA, USA
Full-Time Nurse

Job Description

argenx

The Field Reimbursement Manager (FRM) - North Texas is responsible for managing an assigned territory - northern half of Texas. Focused on supporting access, Reimbursement and Patient Services by providing assistance with patient reimbursement processes for VYVGART. Our ideal candidate will live in either Dallas or Forth Worth.

As the FRM North Texas your duties will include but is not limited to Prior Authorization assistance, Claims Assistance, and Appeals and educating the office on Payer landscape. This position is HCP and customer-facing and requires the ability to build relationships with physician offices as well as other cross functional internal and external stakeholders. The Field Reimbursement Manager works independently in a fast paced, highly visible environment as well as collaboratively with the internal program hub support services to ensure all customer needs are met. Candidate will have extensive experience in both medical and pharmacy benefit acquired medication. Experience in Neurology products is a plus. Must have a strong working knowledge of Medicare and Commercial insurance benefit structures and be able to relay detailed benefit information in order to maximize the HCP and Staff experience. Position will require travel, project management and/or account coordination with other stakeholders.

Key Accountabilities/Responsibilities:

  • Provide on-demand education (including Lunch and Learns or Dinner presentations) for the office staff regarding Reimbursement and support services that are available through argenx
  • Office interaction will include education and reimbursement support both in-person and virtually
  • Educate on Benefit Investigation, Prior Authorization Process, Support Center Services, Medicare and Commercial coverage and patient communication streams
  • Monthly activity reporting captures educational topics at FRM level
  • Provide offices with Product Distribution and Ordering Support and Site of Care Assistance which consists of determining the most appropriate site of care based on the patient's payer preferences and available benefits
  • Reimbursement Support on Case management, billing and coding updates, appropriate claims submission, Specialty Pharmacy, Medical Benefit Interpretation, understanding medical necessity, claims and appeal assistance, information related to co-pay assistance and patient assistance programs
  • FRM will collaborate with case manager and case coordinator on average of 4 x month and ad hoc as needed for escalations, these interactions are tracked in FRM CRM and hub system
  • Coordinate with HCP and staff to obtain and provide patient and provider specific information
  • Provide Aging Case Assistance thorough collaboration with cross functional partners (Case Coordinators, Case Managers, and Regional Account Directors) in order to advance open case referrals. All FRM interactions/activities are tracked in FRM CRM which are reportable to leadership
  • Territory performance will be monitored via FRM CRM dashboard daily, trending results will be identified through quarterly reporting
  • Collaborate with cross-functional partners on overall account and territory strategy to maximize internal/external customer knowledge on payor policy and processes
  • Proactive and reactive managing through conflict; navigate complexity of accounts and patient journey

Desired Skills and Experience:

  • Minimum of 8 years in the healthcare/biotech/pharma industry
  • Minimum of 6 years healthcare related reimbursement experience
  • Exceptional billing and coding experience with CMS 1500/UB-04 forms required strong pharmaceutical and reimbursement experience with Specialty Pharmacy and Buy and Bill proven experience supporting specialty products
  • Neurology experience a plus
  • Experience in the healthcare industry including, but not limited to insurance verification, prior authorizations, and/or claim adjudication, billing and coding
  • Educating on use of miscellaneous J Code and Modifiers for wastage
  • Must have Medicare and commercial insurance coverage experience (limited networks a plus)
  • Must be able to deliver and document benefit investigation outcomes and relay status reports on a regular basis
  • Strong customer service experience
  • Proven presentation skills and experience

#LI-Remote

At argenx we strive to create a welcoming and inclusive environment. Here all applicants will receive equal consideration for employment without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, or any other applicable legally protected characteristics. argenx is proud to be an equal opportunity employer.

If you require reasonable accommodation in completing your application, interviewing, or otherwise participating in the candidate selection process please contact us at [email protected]. Only inquiries related to an accommodation request will receive a response.

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