Field Reimbursement Manager (FRM)

Company Bio:

Medexus Pharmaceuticals Inc. is a leading specialty pharmaceutical company with a focus on the therapeutic areas of rheumatology, auto-immune disease, specialty oncology, allergy, and pediatric diseases. We provide market-leading prescription and over-the-counter brands to patients and healthcare professionals, which we believe greatly enhances quality of life and promotes a healthy lifestyle. We have a strong North American commercial platform, and we currently operate through two unique segments: Medexus Pharma Canada and Medexus Pharma USA. Innovation is a driving force for our company. As a result, we are continuously licensing and/or acquiring new products and solutions aimed at addressing the essential needs of consumers, patients, and healthcare partners.

Role Overview:

Reporting directly to the Sr. Director, Market Access- The Field Reimbursement Manager (FRM) ensures seamless access to Treosulfan by supporting oncology hospitals and transplant centers with reimbursement, coding, precertification, and appeals. Acting as a HIPAA-compliant business associate, the FRM provides expert guidance on payer policies and billing processes.

As a key front-line representative, the FRM collaborates with internal teams—including Sales, Marketing, and Market Access—to deliver exceptional customer support. This role requires expertise in healthcare reimbursement, medical coding, and payer policies, along with strong relationship-building skills to educate hospital and transplant staff.

This opportunity is advertised in multiple locations on LinkedIn to ensure visibility across our hiring region. However, all postings direct to the same application page. Submitting more than one application is not necessary, as all candidates will be considered through a single hiring process.

Key Responsibilities

• Provide reimbursement support for Treosulfan to claims and billing administrators within targeted oncology hospitals and transplant centers.
• Help resolve patient-specific reimbursement, coding, precertification, and appeals issues related to Treosulfan.
• Educate hospital and transplant center staff on Treosulfan coding, reimbursement support services, payer reimbursement and medical policies.
• Collaborate with key stakeholders including hospital/transplant center claims administrators, Treosulfan reimbursement hotline personnel and provider service representatives of payers to help resolve reimbursement issues.
• Support field in education of hospital/transplant center personnel on precertification and appeals processes and reimbursement support through the Treosulfan Reimbursement Support Hotline.
• Develop and implement business plans to support appropriate access to Treosulfan within targeted oncology hospitals and transplant centers.
• Establish and maintain knowledge of the local and national payer landscape for Treosulfan including medical policies and utilization management criteria.
• Establish and maintain knowledge of the specialty distribution landscape for Treosulfan and help to resolve any issues that hospitals and transplant centers are having with ordering and receiving Treosulfan.
• Executes all activities within defined regulatory and compliance standards.
• Achieve and maintain compliance with all applicable Medexus Pharma policies and procedures, regulatory and legal requirements, and help to monitor compliance during cross functional team interactions.

Education, Experience & Skill Requirements

• BA/BS Degree required, preferably in life science or business.
• Coding certification such as Certified Professional Coder (CPC), Certified Coding Specialist (CCS) or Certified Medical Coder (CMC) strongly desired.
• Minimum 7 years of experience in the pharmaceutical/healthcare industry
• Must have 2 years in a reimbursement role supporting hospitals and clinics with medical coding, claims/billing processes and submissions to both private and government insurers for pharmaceutical products.
• Must have experience working with a pharmaceutical product that is used inpatient and reimbursed under a DRG or Case Rate.
• Must have experience working with a pharmaceutical product that is used outpatient and reimbursed as a medical benefit.
• Must have expertise with Medicare and private insurance billing/claim forms including UB-04, 837-I, CMS-1500, 837-P, and EOB and billing codes including DRGs, Case Rates HCPCS codes and J-Codes.
• Must have strong interpersonal skills including managing and resolving conflict and building strong working relationships.

Additional Information

Travel: up to 80% (This role will support approximately ½ of the country and require extensive air travel)

Location: Remote, East USA

Compensation Range: $155,000 - $195,000

We recognize that experience comes in many forms. Even if your background or compensation expectations don’t exactly align with all the qualifications or compensation range listed, we encourage you to apply. Your unique skills and experience may be a great fit for this role or other opportunities at Medexus.

Medexus Pharma is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age, disability or any other characteristic protected by law. We assure you that your opportunity for employment with Medexus Pharma depends solely on your qualifications.