[Hiring] Associate Director, Field Reimbursement @Pacira Pharmaceuticals, Inc.

Role Description

The Associate Director, Field Reimbursement is a customer-facing role reporting to the Senior Director of Market Access & Reimbursement, responsible for managing defined accounts within a specified region in the Non-Opioid Pain Therapeutic area. This role supports a specialty buy-and-bill therapy by driving product reimbursement and coverage, removing access barriers, and partnering with internal and external stakeholders to execute strategic plans. Key responsibilities include:

• Act as an extension of EXPAREL & ZILRETTA, providing live one-on-one coverage support.
• Offer assistance from physician order to reimbursement, supporting the entire Reimbursement journey through payer prior authorization to appeals/denials requirements procedures and forms.
• Review patient-specific information in cases where the site has specifically requested assistance in resolving any issues or coverage challenges.
• Review patient insurance benefit options.
• Coordinate with Pacira’s patient support services programs representatives.
• Educate physician office staff on the use of Pacira’s call center support services, including web-based provider programs.
• Provide information on relevant Reimbursement topics related to Pacira’s portfolio.
• Serve as payer expert for defined geography and communicate changes to key stakeholders in a timely manner.
• Provide office support in accurate coding and billing for Pacira’s portfolio.

Qualifications

• Bachelor’s degree from an accredited college or university in Health Policy, Finance, Business, or other related fields.
• Minimum of 6+ years related experience in the healthcare industry.
• Minimum of 3 years of relevant reimbursement experience, particularly managing targeted reimbursement relationships.

Requirements

• General payer policy knowledge including managed care and Medicare/Medicaid.
• Foundational knowledge of benefit verifications and prior authorization requirements.
• Knowledge of Reimbursement and billing processes within the physician office.
• Ability to review clinical information in patient charts, understand and interpret payer policy to provide guidance to HCP offices on how they may proceed in filling out prior authorization/formulary exception/appeals documentation.
• Specific knowledge of specialty product buy and bill, coding, and in office best practices on program management.
• Proven track record overseeing or managing medical billing and coding including appeals, denials, and single case rates.
• Excellent written and verbal English communication skills including presentation skills to groups of all sizes and at executive levels.
• Demonstrated ability to partner, communicate, and accomplish goals across organization without direct reporting structure.
• Proven ability to think strategically and succeed with limited structure and direction.
• Proven problem-solving, analytic and negotiation skills with high value contracts and partnerships.
• Extensive, proven reimbursement experience.
• Demonstrated understanding of CMS, Commercial payment models and trends.
• Valid driver’s license in the state in which you reside.

Benefits

• Medical, Prescription, Dental, Vision Coverage
• Flexible Spending Account & Health Savings Account with Company match
• Employee Assistance Program
• Mental Health Resources
• Disability Coverage
• Life insurance
• Critical Illness and Accident Insurance
• Legal and Identity Theft Protection
• Pet Insurance
• Fertility and Maternity Assistance
• 401(k) with company match
• Flexible Time Off (FTO) and 11 paid holidays
• Paid Parental Leave