Field Reimbursement Manager, Rheumatology

• 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, assessing education needs and facilitating stakeholder collaboration
• Educate healthcare providers and office staff on product coverage, prior authorizations and appeals, reimbursement processes, claims submissions, procedures, and payer coding requirements
• Collaborate with sales representatives and key account managers as the reimbursement expert for the local team
• 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 aligned to FRM Rules of Engagement
• Build strong, trust-based relationships with customers in assigned Immunology accounts
• Manage territory logistics, routing, and account business planning
• Maintain and grow knowledge of market dynamics, coverage, and coding requirements
• Grow knowledge of hub and specialty distribution channels to improve practice and patient support
• Collaborate with internal J&J departments including marketing, sales, medical science, SCG, IBG, HCC, and PECS
• Serve as subject matter expert on access and affordability solutions across Medicare, Medicaid Managed Care, Commercial, and other payer types
• Complete business activities in accordance with ethical, legal, and compliance standards and required training
• Remain current on product coverage, access knowledge, marketplace conditions, and stakeholder practices
• Adapt resourcing and messaging to healthcare providers and staff based on the changing healthcare ecosystem

Requirements

• 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 hospital and/or provider office setting, building strong customer relationship
• Demonstrated expertise with both 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 in a timely and efficient manner
• Experience working with patient support HUB services
• Valid US driver’s license and a driving record in compliance 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 reimbursement preferred
• Technical knowledge of payer policy, including coding, coverage, and payment preferred
• Salesforce.com CRM, Microsoft Word, and Excel preferred
• Commitment to learning emerging technologies, such as AI, preferred

Core Competencies

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

Highest-signal resume keywords

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

Hard Skills

• Prior Authorization
• Coding
• Billing
• Revenue Cycle Management
• Pharmacy Benefits
• Medical Benefits
• Buy-and-Bill
• Claims Submission
• Payer Coding Requirements
• Patient Support HUB Services

Soft Skills

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

Certifications & Qualifications

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

Industry Keywords

• Immunology
• Medicare
• Medicaid
• Managed Care
• Payer Policy
• Marketplace Conditions
• Healthcare Ecosystem
• Ethical Standards
• Compliance Standards
• Stakeholder Practices

Tools & Technologies

• Salesforce.com CRM
• Microsoft Word
• Microsoft Excel