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

Role Description

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

• Representing Pacira and the value of its products.
• Facilitating understanding of reimbursement services.
• Building relationships with key healthcare influencers.
• Serving as the internal expert on medical coding, billing, and reimbursement.

Responsibilities

• Manage a team of Field Reimbursement Managers (FRM) for a given region providing support and guidance to create optimal reimbursement pathways for our customer base.
• Recruit, hire, train, develop and manage qualified provider-focused FRMs.
• Coach and develop FRMs to function in a highly effective, consistent manner while ensuring legal and regulatory compliance.
• Prepare and deliver performance reviews and Field Coaching Reports (FCR) to FRMs.
• Manage the FRM expense budget within appropriate guidelines and ensure all FRM performance metrics are captured and reported in a timely manner.
• 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.

Supervisory Responsibilities

• This position will be responsible for managing the FRMs in a region.

Interaction

• Work closely with internal departments, such as Marketing, Field Sales, National Accounts, Patient and Provider Services, Clinical Education, Medical Affairs, HEOR, and Corporate Communications/Advocacy.
• Engage with external constituents such as commercial or government payers, various associations and its members, and third-party payer/employer consulting organizations.

Qualifications

• Bachelor’s degree from an accredited college or university in Health Policy, Finance, Business, or other related fields.
• Minimum of 8+ years related experience in the healthcare industry.
• Minimum of 5 years of relevant reimbursement experience, particularly managing targeted reimbursement relationships.
• Minimum of 3 years management experience.

Knowledge, Skills, and Abilities

• Excellent ability to recruit, hire, train, coach and retain experienced managers in the reimbursement field.
• High emotional intelligence in managing multiple business initiatives and cross-functional relationships.
• Financial/budgetary experience preferred.
• Excellent planning, organizational and project management skills.
• 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.
• The Director, Field Reimbursement, must reside within the region that they oversee.

Physical Demands

• Regularly required to sit, talk, move between spaces, reach with hands and arms, and stoop.
• Close vision and the need to focus on computer screen, use of hands, fingers, and wrist to type on keyboard and manipulate mouse.
• Ability to travel at a minimum of 60% of the time.

Work Environment

• Work from home or remote locations such as airports, hotels, and off-site meetings.
• This position may or may not be a typical office setting, staff in cubicles.

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