Director, Reimbursement Strategy – Patient Access Excellence

🔥 20 hours ago

🐎 Kentucky, Tennessee, +1 more states – Remote

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

⏰ Full Time

🔴 Lead

👔 Director

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Helpware

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2015

📦 Logistics

📣 Marketing

💼 Consulting

💰 Seed Round on 2016-01

Logistics • Marketing • Consulting

Helpware is a digitally enabled People as a Services Outsourcer dedicated to enhancing customer experiences for high-growth, market-disrupting, and technology companies. They specialize in providing a wide array of services such as digital customer experience, content control and verification, AI-driven customer service, back-office support, and data labeling. Helpware also assists in areas like digital marketing support, cybersecurity, and software development. Operating globally, they offer culturally aligned and scalable team solutions across multiple countries. Helpware aims to drive brand loyalty and efficiency for its clients by providing human task services integrated with technology solutions.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

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

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