Director, Reimbursement Strategy – Patient Access Excellence

🔥 18 horas atrás

🐎 Kentucky, Tennessee, +1 estados a mais – Remoto

🐎 Kentucky – Remote 🎸 Tennessee – Remote ⚔️ Virginia – Remote

⏰ Tempo Integral

🔴 Especialista

👔 Diretor

👻 Score fantasma 10%

O que significa: a chance de ninguém estar realmente contratando para esta vaga.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Por que essa pontuação:

• Aberta há 1 dia.
• As vagas desta empresa costumam ser preenchidas em 21 dias.
• Sem salário divulgado.

Candidatar-se

Encontrar Vagas Remotas Similares

Helpware

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

Fundada em 2015

📦 Logística

📣 Marketing

💼 Consultoria

💰 Seed Round em 2016-01

Logistics • Marketing • Consulting

A Helpware é uma empresa de terceirização de serviços digitalmente habilitada que se especializa em aprimorar experiências digitais do cliente para empresas de tecnologia em rápido crescimento e que estão revolucionando o mercado. Eles oferecem uma gama de serviços, incluindo atendimento ao cliente com IA, controle e verificação de conteúdo, suporte de back-office, rotulagem de dados, marketing digital, cibersegurança e desenvolvimento de software. A Helpware foca em proporcionar experiências superiores ao cliente e expandir marcas ao integrar serviços de tarefas humanas com soluções tecnológicas. Com locais ao redor do mundo, eles oferecem equipes escaláveis e culturalmente alinhadas em várias indústrias, como eCommerce, SaaS, saúde e finanças.

Descrição

• Serve as the senior subject matter expert for specialty pharmaceutical reimbursement, with emphasis on GLP-1 medications • Provide guidance on commercial insurance, Medicare, Medicaid, pharmacy benefits, and medical benefit structures • Interpret payer requirements, formulary restrictions, step therapy, prior authorization criteria, and coverage limitations • Identify reimbursement trends, payer policy changes, and patient access challenges • Develop recommendations to improve reimbursement accuracy, processing efficiency, and patient access outcomes • Resolve complex prior authorizations, benefit investigations, coverage denials, appeals, and reimbursement barriers • Guide Reimbursement Analysts and operational leadership on technical escalations • Partner with prescribing providers, authorized clinical resources, and client stakeholders • Evaluate workflows and recommend improvements to efficiency, accuracy, consistency, and scalability • Support root-cause analysis of processing errors, aged cases, avoidable denials, and operational inefficiencies • Provide technical coaching, onboarding support, continuing education, and skill development for Reimbursement Analysts and SMEs • Develop payer-specific knowledge resources, technical guidance, standard operating procedures, and escalation frameworks • Participate in quality calibration sessions • Advise clients and senior stakeholders on payer trends, reimbursement barriers, process improvements, and patient access opportunities • Support program launches, process transitions, operational readiness, and program scalability • Help define technical competencies and proficiency expectations for analysts and SMEs • Support consistent reimbursement practices across multiple delivery locations • Collaborate with Operations, Quality Assurance, Training, client stakeholders, and other functional partners

🎯 Requisitos

• Bachelor's degree in healthcare administration, business, pharmacy-related studies, or a related discipline, or equivalent combination of education and directly relevant experience • 8–10+ years of progressive experience in pharmaceutical reimbursement, patient access, specialty pharmacy, healthcare revenue cycle, or related healthcare insurance operations • 3+ years of Director-level experience or equivalent senior functional leadership experience involving reimbursement strategy, complex escalation management, or cross-functional patient access initiatives • Advanced working knowledge of benefit investigations, prior authorizations, appeals, coverage determinations, payer policy interpretation, and reimbursement workflows • Demonstrated experience resolving complex pharmaceutical reimbursement and patient access challenges • Experience providing strategic advisory support to operational leaders, client stakeholders, or senior healthcare professionals • Demonstrated ability to translate technical reimbursement expertise into practical operational solutions • Experience coaching, mentoring, or providing technical direction to reimbursement professionals • Strong analytical, problem-solving, communication, and stakeholder management capabilities • Working knowledge of HIPAA, patient confidentiality, and applicable healthcare reimbursement compliance requirements • Ability and willingness to remain actively engaged in detailed reimbursement workflows while providing senior-level guidance • Preferred: Direct experience with GLP-1 therapies and payer requirements involving Type 2 diabetes and chronic weight management • Preferred: Experience within pharmaceutical manufacturer patient support programs, specialty pharmacy services, patient access hubs, or reimbursement support organizations • Preferred: Familiarity with commercial payer and government-program coverage policies • Preferred: Experience supporting reimbursement operations in a business process outsourcing or third-party service environment • Preferred: Experience supporting large-scale or rapidly expanding reimbursement teams • Preferred: Familiarity with electronic prior authorization systems, payer portals, CRM platforms, and case management applications • Preferred: Relevant pharmacy technician registration, professional certification, or specialized reimbursement credentials, where applicable

🏖️ Benefícios

• Full-time employment • Remote work within Kentucky, Tennessee, or Virginia

📊 Verifique sua pontuação de currículo para esta vaga

Melhore suas chances de conseguir uma entrevista verificando sua pontuação de currículo antes de se candidatar.

Enviar Currículo