Field Reimbursement Manager (Immunology Rheumatology) - San Francisco South, CA

Overview

Field Reimbursement Manager (Immunology Rheumatology) - San Francisco South, CA – Johnson & Johnson HCS, Inc. This field-based role supports patient access to Johnson & Johnson Immunology therapies and will involve on-site engagement with healthcare providers (HCPs) and office staff.

Job Description

The Field Reimbursement Manager (FRM) is responsible for serving as the primary field-based lead for education, assistance, and issue resolution related to patient access to J&J Immunology therapies. Up to 50% of time may be spent on-site with HCPs to assess education needs and collaborate with various stakeholders.

A Day in the Life

Every patient’s healthcare experience is unique. J&J aims to create a personalized, helpful, and hopeful experience. The FRM helps patients start and stay on their medicine by supporting access and adherence across the patient journey.

Primary Responsibilities

• Educate HCPs on product coverage, prior authorizations and appeals, reimbursement processes, claims submissions, procedures, and coding requirements of payer organizations (local payers, government payers, etc.) for core and launch products.
• Collaborate with field support team members (sales representatives and key account managers) and serve as reimbursement expert for the local team.
• Address critical access and affordability issues for patients with a sense of urgency.
• Partner with managed care colleagues to understand current policies and potential changes.
• Conduct field-based reimbursement and access support, education and 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 knowledge of national, regional, local, and account market dynamics including coverage and coding requirements.
• Grow knowledge of hub and specialty distribution channels to support practice and patient needs.
• Collaborate with internal J&J departments and serve as subject matter expert on education and insights on access and affordability across payer types and plans (e.g., Medicare, Medicaid Managed Care, Commercial).
• Ensure activities comply with ethical, legal, and compliance standards and complete required training in a timely manner.

Market Access Expertise

• Extensive knowledge of medication access channels (pharmacy and medical benefits, buy & bill and/or AOB) across multiple sites of care.
• Stay current on changes in product coverage and access, marketplace conditions, and stakeholder practices to deliver effective materials.
• Adapt to the healthcare ecosystem to customize resourcing and messaging to HCPs and staff.

Qualifications

• Bachelor’s degree (preferably in healthcare or business/public administration). MBA or MPH preferred.
• Minimum of 5 years of relevant professional experience.
• Account management and/or reimbursement experience in hospital or provider office settings; strong customer relationships.
• Expertise with both pharmacy and medical/buy & bill benefits, coding, and billing.
• Reimbursement or relevant managed care experience (revenue cycle, buy-and-bill, prior authorization, coding, and appeals).
• Ability to establish relationships, collaborate, and influence across a matrix organization.
• Problem-solving skills to navigate access challenges and identify timely solutions.
• Experience with patient support HUB services.
• Valid US driver’s license and driving record meeting company standards.
• Ability to travel up to 50%.
• Permanent residence in the listed territory.

Preferred

• Immunology disease state experience.
• Advanced degree and/or certifications in prior authorization and/or billing and coding.
• Strong market access acumen related to payer approval processes and business acumen.
• Understanding of Medicare, Medicaid, and private payer initiatives affecting reimbursement.
• Technical knowledge in payer policy including all elements of reimbursement (coding, coverage, payment).
• Experience with Salesforce CRM, Microsoft Word and Excel.

The estimated base pay range is $100,000 to $175,000 per year. This role is eligible for a company car through the Fleet program. Benefits include medical, dental, vision, life insurance, disability, and retirement plans, with time-off provisions as described in the company policies.

Equal Opportunity

Johnson & Johnson is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, age, national origin, disability, protected veteran status, or other characteristics protected by law. Reasonable accommodations are available on request for applicants with disabilities.