Associate Director, Field Reimbursement

Summary:

The Associate Director, Field Reimbursement is a customer-facing role reporting to the Senior Director of Market Access & Reimbursement, responsible for managing defined accounts within a specified region in the Non-Opioid Pain Therapeutic area. This role supports a specialty buy-and-bill therapy by driving product reimbursement and coverage, removing access barriers, and partnering with internal and external stakeholders to execute strategic plans. Key responsibilities include representing Pacira and the value of its products, facilitating understanding of reimbursement services, building relationships with key healthcare influencers, and serving as the internal expert on medical coding, billing, and reimbursement.

Essential Duties & Responsibilities:

The following statements are intended to describe the general nature and level of work being performed by an individual assigned to this job. Other duties may be assigned.

• Act as an extension of EXPAREL & ZILRETTA, provide live one-on-one coverage support.
• Offer assistance from physician order to reimbursement, supporting the entire Reimbursement journey through payer prior authorization to appeals/denials requirements procedures and forms.
• Reviewing patient-specific information in cases where the site has specifically requested assistance in resolving any issues or coverage challenges.
• Reviewing patient insurance benefit options
• Coordinating with Pacira's patient support services programs representatives.
• Educating physician office staff on the use of Pacira's call center support services, including web-based provider programs.
• Provide information on relevant Reimbursement topics related to our Pacira's portfolio.
• Serve as payer expert for defined geography and able to communicate changes to key stakeholders in a timely manner.
• Provide office support in accurate coding and billing for Pacira's portfolio.

Supervisory Responsibilities:

This position will not have supervisory responsibilities.

Interaction:

The incumbent will work closely with internal departments, such as Marketing, Field Sales, National Accounts, Clinical Education, Medical Affairs, HEOR and Corporate Communications/Advocacy, as well as with external constituents such as commercial or government payers, various associations and its members and third-party payer/employer consulting organizations.

Education and Experience:

• Bachelor's degree from an accredited college or university in Health Policy, Finance, Business, or other related fields.
• Minimum of 6+ years related experience in the healthcare industry.
• Minimum of 3 years of relevant reimbursement experience, particularly managing targeted reimbursement relationships.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Knowledge, Skills, and Abilities:

• General payer policy knowledge including managed care and Medicare/Medicaid
• Foundational knowledge of benefit verifications and prior authorization requirements
• Knowledge of Reimbursement and billing processes within the physician office
• Ability to review clinical information in patient charts, understand and interpret payer policy to provide guidance to HCP offices on how they may proceed in filling out prior authorization/formulary exception/appeals documentation.
• Specific knowledge of specialty product buy and bill, coding, and in office best practices on program management.
• Proven track record overseeing or managing medical billing and coding including appeals, denials, and single case rates.
• Excellent written and verbal English communication skills including presentation skills to groups of all sizes and at executive levels.
• Demonstrated ability to partner, communicate, and accomplish goals across organization without direct reporting structure.
• Proven ability to think strategically and succeed with limited structure and direction.
• Proven problem-solving, analytic and negotiation skills with high value contracts and partnerships.
• Extensive, proven reimbursement experience
• Demonstrated understanding of CMS, Commercial payment models and trends.
• Valid driver's license in the state in which you reside.

Physical Demands:

While performing the duties of this job, the employee is regularly required to sit, talk, move between spaces, reach with hands and arms, and stoop. Close vision and the need to focus on computer screen, use of hands, fingers, and wrist to type on keyboard and manipulate mouse. Ability to travel at a minimum of 75% of the time.

Work Environment:

Work from home or remote locations such as airports, hotels and off-site meetings. This position may or may not be a typical office setting, staff in cubicles. Noise level is moderate such as consistent printer, telephone ringing, conversation, airport paging and airplane noise.

• Medical, Prescription, Dental, Vision Coverage
• Flexible Spending Account & Health Savings Account with Company match
• Employee Assistance Program
• Mental Health Resources
• Disability Coverage
• Life insurance
• Critical Illness and Accident Insurance
• Legal and Identity Theft Protection
• Pet Insurance
• Fertility and Maternity Assistance
• 401(k) with company match
• Flexible Time Off (FTO) and 11 paid holidays
• Paid Parental Leave

The base pay range for this role is $141,200 to $175,000 per year. The range is what we reasonably expect to pay for this role. The range considers a wide range of factors that are considered in making compensation decisions, including but not limited to: geographic markets, business or organizational needs, skill sets, experience, training, licensure, and certifications.

EEO Statement

EEO Statement: Pacira is proud to be an Equal Opportunity Employer and does not discriminate against applicants because of race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age (40 or older), veteran status, disability or genetic information, or any other characteristic protected under applicable federal, state, or local law. At Pacira we are committed to intentionally cultivating a culture of inclusion where all feel welcomed and valued for their background, perspectives, and experiences. We hold one another accountable to promote trust and transparency in support of our communities and collective purpose.
Agency Disclaimer: Pacira Biosciences, Inc. (Hereafter, Pacira) does not accept unsolicited resumes from recruiters or employment agencies in response to the Pacira Careers page or a Pacira social media post. Pacira will not consider or agree to payment of any referral compensation or recruiter fee relating to unsolicited resumes. Pacira explicitly reserves the right to hire said candidate(s) without any financial obligation to the recruiter or agency. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Pacira.