Field Reimbursement Program Team Lead

Field Reimbursement Program Team Lead

Mercalis is an integrated life sciences commercialization partner that provides comprehensive solutions that span the entire healthcare value chain. Backed by proven industry expertise and results-driven technology, Mercalis helps navigate the complex life sciences marketplace by providing commercialization solutions to accelerate value and enhance patient lives.

Mercalis fosters a culture that encourages individuality and provides opportunities for creativity, growth, and success while fostering a team environment. We are a diversity-driven organization with an inclusive approach to delivering patient-centric solutions that eliminate barriers for patients and increase patient access to life-altering medications.

The Field Reimbursement Program Team Lead will lead the strategy, buildout, and oversight of a national hybrid access team (primarily virtual) supporting a novel therapy for a rare, progressive metabolic condition requiring weekly healthcare provider-administered injections. The product's complexity and chronic dosing schedule demand a high-touch engagement model with close coordination between provider offices, specialty pharmacy, payers, and patients.

This role will oversee a team of Field Reimbursement Managers (FRMs), many of whom operate in a Patient Access Manager (PAM)-style capacity, engaging directly with patients and caregivers to address access barriers, educate on logistics, and ensure ongoing adherence support. The Director may also be responsible for expanding into other programs within chronic disease portfolios.

The ideal candidate is a self-starting builder with experience leading national FRM or PAM teams, a strong track record of standing up compliant, efficient, and effective programs, and deep familiarity with both provider-facing and patient-facing access strategies.

Responsibilities

• Solve complex patient access issues by working across the Hub, provider offices and communicating with client field team.
• Partner with Sales Team, Marketing, HCP, Specialty Pharmacies to create and drive strategic reimbursement support approaches, resulting in increased access to therapy for individual patients.
• Educate HCP and Office Staff on Patient Support Programs, per program specific operating policies and patient journey.
• On occasion, lead HCP offices in onsite education of program business rules, payer coverage, and other reimbursement related activities.
• The FRM will manage daily activities that support appropriate patient access to client's products across relevant sites of care to work as an extension of the HUB reimbursement support services offered to providers.
• Review patient benefit options, prior authorization requirements, and alternate funding / financial assistance programs.
• Review appropriate billing and coding for products, assist with resolving reimbursement issues, and help ensure appropriate education to avoid future reimbursement hurdles.
• Coordinate with client's patient support services programs representatives on patient cases and claim issues.
• Educate office staff on the use of client's patient assistance and reimbursement support services, including but not limited to web-based provider programs and tools, and provide information on relevant reimbursement topics related to client's products.
• Conduct policy surveillance across regional payers to ensure appropriate coding, coverage, and payment of client's products.
• Assist providers with understanding local payer coverage and reimbursement trends through educational breakfast, lunch, and dinner programs.
• Lead sales training related to product reimbursement, as appropriate.
• Communicate reimbursement concerns and issues with appropriate internal stakeholders, including Sales and Managed Markets.
• Understand and monitor national and regional payer trends and changes.
• Work collaboratively with Managed Markets team to escalate potential payer issues.
• Operate in Compliance with HIPAA within program guidelines.
• On time adherence to training deadlines for all corporate policies and procedures governing access to confidential data
• Ensure all SOPs are followed with consistency
• Conducts miscellaneous tasks or projects as assigned

Qualifications