Valeris (formerly) Mercalis is an integrated life sciences commercialization partner that provides comprehensive solutions that span the entire healthcare value chain. Backed by proven industry expertise and results-driven technology, Mercalis helps navigate the complex life sciences marketplace by providing commercialization solutions to accelerate value and enhance patient lives.

Mercalis fosters a culture that encourages individuality and provides opportunities for creativity, growth, and success while fostering a team environment. We are a diversity-driven organization with an inclusive approach to delivering patient-centric solutions that, eliminate barriers for patients, and increase patient access to life altering medications.

As a Hybrid Field Reimbursement Manager (HFRM), you will help increase patient access to critical therapies by resolving access challenges, educating healthcare provider (HCP) offices on billing and reimbursement, and supporting sites of care both virtually and directly. You will collaborate with office staff, billing teams, specialty pharmacies, and patient support vendors (HUB, copay card, PAP) to remove access barriers. The HFRM will be HCP-facing and serve as the subject-matter expert on reimbursement, coverage, prior authorizations, and appeals processes.

Target geographies include the Dallas-Fort Worth (DFW) area and the Northeast U.S., which align with the locations of key opinion leaders (KOLs) and broader field sales presence from our clients commercial organization. 

Your Responsibilities:

• Educate accounts and caregivers on enrollment to the specialty pharmacy, program services, payer coverage and benefit design, affordability, billing and coding, prior authorization, appeals support, scheduling and in-home nursing administration and financial assistance programs.
• Solve complex patient access issues by working across the Hub, specialty pharmacies, caregiver provider offices and communicating with client field team.
• Partner with client’s Sales/Account Management Team,  HCPs, and  network Specialty Pharmacy to create and drive strategic reimbursement support approaches, resulting in increased access to therapy for individual patients.
• Educate HCP and Office Staff on Patient Support Programs, per program specific operating policies and patient journey.
• On occasion, lead HCP offices in onsite education of program business rules, payer coverage including review of relevant coding options, including miscellaneous J-codes, at launch as well as other reimbursement related support.
• Guide healthcare providers through the prior authorization and appeals process, educating on required documentation, payer-specific requirements, and outcome communication.
• The HFRM will manage daily activities that support appropriate patient access to client’s products across relevant sites of care to work as an extension of the support services offered to providers.
• Review patient benefit options for an infused therapy including prior authorization requirements, and appeals .
• Review appropriate billing and coding for products, assist with resolving reimbursement issues, and help ensure appropriate education to avoid future reimbursement hurdles.
• Coordinate with client’s patient support services programs representatives on patient cases and claim issues.
• Educate office staff on the use of client’s patient assistance and reimbursement support services, including but not limited to web-based provider programs and tools, and provide information on relevant reimbursement topics related to client’s products.
• Conduct policy surveillance across regional payers to ensure appropriate coding, coverage, and payment of client’s products.
• Assist providers with understanding local payer coverage and reimbursement trends through educational breakfast, lunch, and dinner programs.
• Communicate reimbursement concerns and issues with appropriate internal stakeholders, including Sales and Managed Markets.
• Understand and monitor national and regional payer trends and changes.
• Work collaboratively with Managed Markets team to escalate potential payer issues.
• Operate in Compliance with HIPAA within program guidelines.
• On time adherence to training deadlines for all corporate policies and procedures governing access to confidential data
• Ensure all SOPs and BRDs are followed with consistency
• Conducts miscellaneous tasks or projects as assigned

Preferred Qualifications

• Associate's degree or higher in a related field or equivalent market experience
• 3+ years in Case Management Reimbursement Experience
• 3+ in the Pharma/Healthcare industry; working with Hubs, Payers, HCP or related area
• Must have specific practice management, billing and/or coding experience for drugs, biologicals, or devices.
• Must have general payer policy knowledge including public and private payers, foundational knowledge of medical benefit verifications and prior authorization/pre-determination requirements and knowledge of reimbursement processes within various sites of care.
• Demonstrated ability to conduct field-based reimbursement support and education
• Experience with new product launches, reimbursement billing, coding, and appeals process.
• Knowledge of private payer, Medicare and Medicaid structure, systems, and reimbursement process.
• Migraine or Neurology background
  - Experience with closed network, limited distribution SP
  - PACS certification (if still applicable)
  - Sales experience is a plus
  - Strong focus on communication
• Strong presentation skills

Location Preferences:

This is primarily a hybrid role (80% virtual and 20% in-person) with limited in-person interaction expected.

Target geographies include the Dallas-Fort Worth (DFW) area and the Northeast U.S., which align with the locations of key opinion leaders (KOLs) and broader field sales presence from our client's commercial organization

While proximity to these areas is ideal, the geography does not need to be exact.

- Travel Requirements:

• Job may require up to 20% travel
• Additional travel will be required for various national meetings, training programs and POAs
• Valid Driver’s License for when travel required

Why work for Valeris (formerly Mercalis)?

• Diversity, Equity, Inclusion & Belonging are paramount to our culture and success. Our dedication to DEI&B is both organic and intentional
• Our Mission is rewarding and fulfilling (Patient Access to Life-Saving/Improving/Extending Medications/Treatments)
• We employ the best Talent and Tools from the Patient Access Industry (We are the Industry Leader)
• We monitor the market to ensure we offer competitive salaries and benefits.
• 401K w/ 5% matching; day-1 vestment period
• 15 days PTO
• 8 Holidays + 2 Floating Days
• Health/Dental/Vision/Life; Coverage Day-1
• Gym Reimbursement
• Volunteer Hours

About Us

Valeris (formerly Mercalis) is an integrated life sciences commercialization partner providing comprehensive solutions across the healthcare value chain. Backed by deep industry expertise and results-driven technology, we accelerate value for clients and improve patients' lives by eliminating access barriers and expanding availability of life-changing therapies.

We foster a culture of individuality, inclusion, and collaboration—offering opportunities for creativity, professional growth, and meaningful impact in a team-driven environment.