Field Reimbursement Manager, GI

• Serve as the primary field-based lead for education, assistance, and issue resolution regarding patient access to J&J Immunology therapies
• Spend up to 50% of time on-site with healthcare providers, assess education needs, and facilitate stakeholder collaboration
• Educate healthcare providers on product coverage, prior authorizations, appeals, reimbursement processes, claims submissions, procedures, and payer coding requirements
• Collaborate with sales representatives and key account managers as the local reimbursement expert
• Address critical patient access and affordability issues with urgency
• 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 under FRM Rules of Engagement
• Build trust-based relationships with customers in assigned Immunology accounts
• Manage territory logistics, routing, and account business planning
• Maintain knowledge of market dynamics, coverage, and coding requirements
• Develop knowledge of hub and specialty distribution channels to improve practice and patient support
• Collaborate with internal J&J departments and provide subject-matter expertise on access and affordability solutions across payer types
• Complete business activities in accordance with ethical, legal, compliance, and training requirements
• Remain current on product coverage, access knowledge, marketplace conditions, and stakeholder practices
• Customize resourcing and messaging for healthcare providers and their staff as the healthcare ecosystem changes

• Bachelor’s degree, preferably in healthcare or business/public administration
• Minimum of 5 years of relevant professional experience
• Account Management and/or Reimbursement experience working in the provider office setting
• Demonstrated expertise with pharmacy and medical/buy & bill benefits, coding, and billing
• Reimbursement or relevant managed care experience, including 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 identify solutions
• Superior written and verbal communication skills and efficient follow-through
• Experience working with patient support HUB services
• Valid US driver’s license and driving record compliant with company standards
• Ability to consistently maintain up to 50% travel
• Permanent residence in the listed territory
• Immunology disease state experience preferred
• Advanced degree and/or relevant certifications in prior authorization and/or billing and coding preferred
• Strong market access and business acumen preferred
• Understanding of Medicare, Medicaid, and private payer initiatives affecting pharmaceutical and biotechnology reimbursement preferred
• Technical knowledge of payer policy, including coding, coverage, and payment preferred
• CRM, Microsoft Word, and Excel proficiency preferred
• Commitment to learning emerging technologies such as AI preferred

Demonstrates expertise in patient access and reimbursement processes, including prior authorization, coding, and appeals. Builds strong relationships with healthcare providers while navigating complex market dynamics and compliance requirements.

• Patient Access Expertise
• Reimbursement Experience
• Account Management
• Healthcare Provider Education
• Market Access Knowledge

• Prior Authorization
• Coding
• Billing
• Revenue Cycle Management
• Pharmacy Benefits
• Medical Benefits
• Buy-and-Bill Processes
• Claims Submission
• Payer Coding Requirements
• Immunology Disease State Knowledge

• Relationship Building
• Collaboration
• Problem-Solving
• Communication
• Influencing

• Advanced Degree in Healthcare or Business
• Relevant Certifications in Prior Authorization
• Billing and Coding Certifications

• Managed Care
• Medicare
• Medicaid
• Payer Policy
• Pharmaceutical Reimbursement
• Biotechnology Reimbursement
• Compliance Standards
• FRM Rules of Engagement

• CRM
• Microsoft Word
• Microsoft Excel
• Patient Support HUB Services