Coding Jobs in Riverside, CA

Field Reimbursement Manager

Johnson & Johnson Innovative Medicine's Patient Engagement and Customer Solutions (PECS) team is recruiting for a Field Reimbursement Manager for the San Diego, CA territory, which includes San Diego, CA, Las Vegas, NV, San Bernardino, CA and Riverside, CA.

PECS is committed to setting the standard on Patient Experience (Px), building more personalized, seamless, and supportive experiences to help patients start and stay on treatments across the portfolio.

Job Description:

An important aspect of patient unmet need includes helping them start and stay on their medicine for the best chance at treatment success. The Patient Engagement and Customer Solutions (PECS) organization serves patients, during their treatment journey with Janssen therapies, to help overcome challenges to fulfillment, on-boarding, and adherence.

The Field Reimbursement Manager (FRM) is responsible for serving as the primary field-based lead for education, assistance, and issue resolution with healthcare providers (HCPs) and their office staff, with respect to patient access to J&J Neuroscience therapies. This role involves investing time (up to 50%) on-site with HCPs and HCP staff, assessing their education needs and facilitating collaboration with various stakeholders.

Primary Responsibilities:

• Educate HCPs on reimbursement processes, claims submissions, procedures, and coding requirements of payer organizations (local payers, government payers, etc.)
• Effectively collaborate with field support team members such as sales representatives and key account managers and serve as access, fulfillment, and reimbursement expert for the local team
• Lead compliant access and fulfillment discussions with field support team members
• Utilize data and account management skills to proactively address access barriers
• Act with a sense of urgency and accountability to address critical access and affordability issues for patients
• Partner with managed care colleagues to understand current policies and potential future changes
• Conduct field-based reimbursement and access support, education and creative problem-solving aligned to FRM Rules of Engagement
• Build strong, trust-based relationships with customers in all assigned accounts
• Manage territory logistics, routing, and account business planning
• Maintain and grow knowledge of national, regional, local, and account market dynamics including coverage and coding requirements
• Grow the knowledge of hub and specialty distribution channels to improve practice and patient support needs
• Collaborate with internal J&J departments such as marketing, sales, medical science, SCG, IBG, HCC, and PECS. Serve as subject matter expert regarding education and insights on access and affordability solutions across multiple payer types and plans (i.e., Medicare, Medicaid Managed Care, Commercial).
• Execute business in accordance with the highest ethical, legal, and compliance standards, including timely and successful completion of all required training

Experience & Skills:

• Extensive knowledge of medication access channels (i.e., pharmacy and medical benefit including buy & bill and/or assignment of benefit (AOB))
• Demonstrates critical thinking
• Ability to analyze highly complex, quantitative and qualitative data to accelerate speed to access
• Ambitious and possess a high degree of intellectual curiosity
• Remains current on and anticipates changes in product coverage and access knowledge, marketplace conditions, and stakeholder practices to deliver the most effective delivery of approved materials
• Understands and adapts to the changing healthcare ecosystem to customize resourcing and messaging to HCPs and HCP staff

Required Qualifications:

• Bachelor's degree (preferably in healthcare or business/public administration). An advanced business degree (MBA), or public health (MPH)) is preferred.
• Minimum of 5 years of relevant professional experience
• Account Management and/or Reimbursement experience working in the provider office setting, building strong customer relationship
• Demonstrated expertise with both pharmacy and medical/buy & bill benefit design, coding, billing, prior authorizations, office operations, and appeals processes
• Reimbursement or relevant managed care experience (revenue cycle, buy-and-bill, prior authorization, coding, and appeals processes)
• Ability to establish relationships, collaborate, and influence across a matrix organization
• Problem-solving ability to navigate challenging access scenarios and identifies solutions in a timely and efficient manner
• Superior communication skills (written and verbal) and efficient follow-through
• Experience in working with patient support HUB services
• Valid US driver's license and a driving record in compliance with company standards
• Permanent residence in the listed territory

Preferred Qualifications:

• Neuroscience disease state experience
• Advanced degree and/or relevant certifications in prior authorization and/or billing and coding
• Strong market access acumen as it relates to payer approval processes and business acumen
• Understanding of Medicare, Medicaid, and private payer initiatives affecting reimbursement of pharmaceutical and biotechnology products
• Excellent technical knowledge and expertise in payer policy, including all elements of reimbursement (coding, coverage, and payment) is preferred
• Demonstrated competence with salesforce.com CRM use, Microsoft Word, and Excel
• Demonstrated commitment to learning emerging technologies, such as AI, through exploration, iteration, and apply new tools over time

This role involves travel up to 75 % of the time.

Johnson & Johnson is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, age, national origin, disability, protected veteran status or other characteristics protected by federal, state or local law. We actively seek qualified candidates who are protected veterans and individuals with disabilities as defined under VEVRAA and Section 503 of the Rehabilitation Act.

Johnson & Johnson is committed to providing an interview process that is inclusive of our applicants' needs. If you are an individual with a disability and would like to request an accommodation, external applicants please contact us via and internal employees contact AskGS to be directed to your accommodation resource.

Required Skills:

Preferred Skills:

Account Management, Analytical Reasoning, Competitive Landscape Analysis, Compliance Management, Cross-Functional Collaboration, Developing Others, Fact-Based Decision Making, Inclusive Leadership, Leadership, Market Access Reimbursement, Market Opportunity Assessment, Operational Excellence, Performance Measurement, Pricing Strategies, Relationship Building, Strategic Thinking, Team Management

The anticipated base pay range for this position is :

$102,000.00 - $177,100.00

Additional Description for Pay Transparency:

Subject to the terms of their respective plans, employees are eligible to participate in the Company's consolidated retirement plan (pension) and savings plan (401(k)).Subject to the terms of their respective policies and date of hire, employees are eligible for the following time off benefits: Vacation 120 hours per calendar year Sick time - 40 hours per calendar year; for employees who reside in the State of Colorado 48 hours per calendar year; for employees who reside in the State of Washington 56 hours per calendar year Holiday pay, including Floating Holidays 13 days per calendar year Work, Personal and Family Time - up to 40 hours per calendar year Parental Leave 480 hours within one year of the birth/adoption/foster care of a child Bereavement Leave 240 hours for an immediate family member: 40 hours for an extended family member per calendar year Caregiver Leave 80 hours in a 52-week rolling period10 days Volunteer Leave 32 hours per calendar year Military Spouse Time-Off 80 hours per calendar yearFor additional general information on Company benefits, please go to: -