From intake to outcomes, CareMetx is dedicated to delivering industry-leading patient access solutions and support services that help patients quickly start and stay on specialty therapy treatments. We provide scalable, efficient digital hub services for pharmaceutical companies and healthcare providers, streamlining workflows with seamless integration for patient enrollment, consent, and prior authorization. Our best-in-class patient support services enhance every step of care, connecting patients, providers, and brands to drive better outcomes and accelerate time-to-therapy.

Job Title: Field Reimbursement Team Liaison I

Description

Liaison 1 will serve as the primary point of contact with the client’s field reimbursement team leaders and with specialty pharmacy partners to ensure open communication and resolution for problems in support of eliminating barriers for patients and providers to access therapy. The Field Reimbursement Team Liaison  will be responsible for building a team environment with applicable Client field counterparts and Client Market Access personnel supporting open communication, performing root cause analysis of issues, tracking issues through to resolution, and ensuring program enhancements, process changes and program updates are shared back to the client’s field teams, Healthcare providers and specialty pharmacies. They will serve as a patient journey navigator to the client and the providers to ensure all opportunities for improving patient access can be pursued.

Under the general direction of the Operations Leadership, the Field Reimbursement Team

Liaison 1 will serve as the primary point of contact with the client’s field reimbursement team leaders and with specialty pharmacy partners to ensure open communication and resolution for problems in support of eliminating barriers for patients and providers to access therapy. The Field Reimbursement Team Liaison 1 will be responsible for building a team environment with applicable Client field counterparts and Client Market Access personnel supporting open communication, performing root cause analysis of issues, tracking issues through to resolution, and ensuring program enhancements, process changes and program updates are shared back to the client’s field teams, Healthcare providers and specialty pharmacies. They will serve as a patient journey navigator to the client and the providers to ensure all opportunities for improving patient access can be pursued.

PRIMARY DUTIES AND RESPONSIBILITIES:

1. Partner with internal and external stakeholders to      identify, anticipate and address patient and administrative process fulfillment      and reimbursement issues.
2. Manage ad hoc/urgent escalations as needed;      recognize impact and report major escalations and issues to CareMetx      Operational and Executive Sponsor leadership and Client leadership as      needed.
3. Be a subject matter expert on the payer landscape      related to applicable disease state.

4. Weekly monitoring of reports and dashboards capturing prescription intake, claim status and outcomes, discontinuations, patient access program activity to complete core responsibilities.

5. Proactively identify, organize, summarize and present market access industry trends to Field Team leads.

1. Ensure processes are in place to drive clear      communication with other field-facing teams to ensure clarity of      reimbursement and access barriers.
2. Provide exceptional customer service to internal      and external customers; resolve any customer requests in a timely and      accurate manner; escalate complaints accordingly.
3. Collaborate, communicate, and integrate closely      with cross functional partners / vendors and share customer feedback, as      applicable.
4. Communicate with provider office staff on how to      use patient access programs and services.
5. Maintain thorough knowledge of Client’s Product(s).
6. Participate as needed in client’s virtual or in-person      meetings to represent the operational program.
7. Prepare ad-hoc reports for CareMetx or Client      leadership  as needed.

13. Address and respond to individual customer escalations that involve possible access barriers  (i.e. coding errors, understanding prior authorization/appeal process, copay program enrollment, etc.) in collaboration with key stakeholders, including clients, specialty pharmacy, copay vendor and internal teams as directed by policy and procedure.

14. Partner with appropriate CareMetx cross functional teams (i.e., training, quality) to identify, develop and provide training for the operational team as needed.

1. Travel overnight (10% - 15% travel      required) for conferences or client meetings.

16. Maintain regular and reliable attendance, including being present, on time, and prepared for work as scheduled.

17. Maintain regular and reliable attendance, including being present, on time, and prepared for work as scheduled.

18. Other duties as assigned - Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.

Qualifications

EXPERIENCE AND EDUCATIONAL REQUIREMENTS:

· Advanced degree or relevant pharmaceutical experience preferred

· 5+ years’ experience with specialty providers or Specialty Pharmacies in support of reimbursement and/or reimbursement hubs

• 2+ years of leadership experience, preferably in      the healthcare industry
• Prior experience as a Field Reimbursement Manager      or equivalent experience
• Proven track record of supporting HCPs and office      staff in seeking access/reimbursement that requires significant payer and      reimbursement support
• Experience with both ‘buy and bill’ and Specialty      Pharmacy distribution pathways for specialty oral and injectable      medications
• Strong knowledge of the payer environment,      including but not limited to: government and commercial payers, assignment      of benefits, letter of agreements, accumulators, maximizers, manufacturer      financial assistance
• Ability to professionally interact with customers,      HCPs or HCP Staff members, Specialty Pharmacies, and clients
• Strong knowledge of patient support programs      including: HUB, co-pay assistance, patient financial assistance and adherence      
• Strong planning and organization skills      including OFFICE suite of productivity tools

MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS:

1. Ability to communicate effectively both orally and in writing.
2. Ability to build productive internal/external working relationships.
3. Ability to analyze, interpret, and understand payer, provider, and patient data and trends.
4. Strong interpersonal and leadership skills.
5. Strong organizational skills; attention to detail.
6. Ability to manage multiple tasks.
7. Extensive knowledge in areas of reimbursement and billing including Medicare, Medicaid, commercial coverage in medical, pharmacy and office administered products.
8. General knowledge of healthcare from a patient and provider perspective (miscellaneous codes, billing codes, appeals process).
9. Ability to resolve associate issues effectively and efficiently.
10. Ability to proficiently use Microsoft Excel, Outlook and Word.
11. Ability to problem solve.
12. Willingness to travel up to 10% - 15% of the time

Physical Demands

 The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. · While performing the duties of this job, the employee is regularly required to sit. · The employee must occasionally lift and/or move up to 10 pounds. Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Schedule

• Must be flexible on schedule and hours
• Overtime may be required from time to time