Access & Reimbursement Manager

About Stratis Group:

Stratis Group is an independent pharmaceutical consulting firm specializing in commercialization throughout a brand’s lifecycle, focusing on market access, patient services, field reimbursement, and data-driven analytics.

Summary:

The Access & Reimbursement Manager will serve as a dedicated resource in a contracted, field-based role within an assigned territory. This role involves supporting patient access by educating provider offices on payer requirements, reimbursement processes, patient support services, and approved access resources. The ARM will educate targeted healthcare providers and office staff, including primary care, cardiology, and other specialties, regarding access services and reimbursement solutions specific to cardiovascular products.

The ARM will develop and execute a territory access plan, prioritize accounts based on client-defined objectives, and coordinate compliantly with sales, market access, patient services, hub/specialty pharmacy partners, and other stakeholders. Responsibilities include ensuring understanding of reimbursement processes in Retail Pharmacy, field reimbursement services, and payer landscape. The role requires compliance with defined Rules of Engagement (ROE) and may involve patient-level access and reimbursement issue resolution, with access to PHI only as authorized.

The ARM will demonstrate a compliant and consultative approach to help offices obtain insurance authorization and/or reimbursement for products, impacting the positive experience for both healthcare providers and patients.

Additional Responsibilities:

• Manage daily activities supporting patient access to products in provider offices and act as a liaison to other patient assistance and access support services.
• Provide expertise in Retail and Specialty Pharmacy drug Prior Authorizations, Appeals, and Denials.
• Conduct in-person customer visits.
• Participate in client meetings and regularly scheduled internal team and cross-functional meetings, documenting call activities in the CRM.
• Serve as the local access and reimbursement expert, monitoring payer policy, formulary coverage, utilization management requirements, pharmacy access pathways, prior authorization trends, denial patterns, and other access barriers. Communicate relevant changes and insights to internal stakeholders.
• Educate offices on access processes, including formulary coverage, coding, insurance forms, benefits investigation, prior authorization, appeal, and claims resolution.
• Use only client-approved materials, messaging, processes, and resources when engaging with healthcare providers and partners.

• Identify and communicate field access insights, payer trends, office workflow barriers, and reimbursement challenges to support continuous improvement.
• Recognize and report adverse events, product complaints, and other reportable information in accordance with client policy.

Desired Job Requirements:

• 3+ years of experience in Managed Care, Field Reimbursement, Patient Services, Sales (Specialty or Biologics), or healthcare provider office practice management.
• A 4-year degree in a related field or equivalent experience.
• Experience in Cardiovascular/Cardiology and Hospital Healthcare Systems is a plus.
• The ability to travel 3-4 days a week, including overnights, and reside within the assigned territory.
• Solution-oriented mindset, strong business acumen, and strong analytic capabilities.
• Experience and understanding of Retail Pharmacies and Specialty Pharmacies.
• Demonstrated ability to educate offices on access processes and issue resolution.
• Experience educating HCPs and office staff on client-specific Patient Service programs (e.g., copay).
• Experience delivering educational presentations in person or via technology platforms like Zoom, Webex, and Teams.
• Advanced knowledge of medical insurance terminology.
• Knowledge of Centers for Medicare & Medicaid Services (CMS) policies and processes, with expertise in Medicare (Part D for Pharmacy Benefit products).
• Proven ability to develop and maintain trusted relationships with internal partners and effectively work in teams.
• Ability to manage ambiguity and problem-solve.
• Prepare and submit appropriate expense reports in a timely manner.
• A valid Driver’s License.