Field Reimbursement Manager, Retina

Thea Pharma US

. Conduct pre-launch and immediate post-launch billing and coding workshops for high-volume retina practices .

Posted 9/23/2026full-timeRemote • Massachusetts • United StatesMid-LevelSenior💰 $200,000 - $230,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in billing and coding for retina practices, with a strong focus on J-code, CPT, and ICD-10 coding. Proficient in navigating payer policies and providing reimbursement guidance in a fast-paced healthcare environment.

Highest-signal resume keywords

Buy-And-Bill Product Launch ExperienceOphthalmology/Retina KnowledgeMedicare Part B and D UnderstandingClaims Submission and Denial ResolutionMicrosoft Office Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

J-Code CodingCPT CodingICD-10 CodingClaims SubmissionReimbursement AnalysisPatient Access SupportBilling Workshop FacilitationProblem-Solving for Denied ClaimsCompliance AdherenceInventory Management

Soft Skills

Exceptional Presentation SkillsStrong Problem-Solving SkillsCollaboration in Matrixed Environments

Tools & Technologies

CRM PlatformsPatient Support Program HubMicrosoft WordMicrosoft ExcelMicrosoft PowerPointMicrosoft TeamsMicrosoft Outlook

Certifications & Qualifications

CPC CertificationCHC CertificationPACS Certification

Industry Keywords

Specialty BiologicsManaged MedicaidMedicare PoliciesOIG GuidanceHIPAA ComplianceField ReimbursementPatient Assistance ProgramsBuy-And-Bill OperationsASCsHigh-Volume Retina Practices

About the role

Key responsibilities & impact

Conduct pre-launch and immediate post-launch billing and coding workshops for high-volume retina practices
Educate practices on submitting claims using new permanent J-Code HCPCS codes and support the transition once ASP is established
Monitor initial claim submissions and troubleshoot payer rejections or clearinghouse formatting errors
Provide reimbursement, coverage, and access expertise to retina practices, ASCs, and hospital outpatient departments
Educate clinic staff, billing personnel, and practice managers on payer policies, prior authorization, claims submission, and J-code, CPT, and ICD-10 coding
Analyze and help resolve denied claims, underpayments, and complex appeals with compliant guidance
Guide practices on buy-and-bill operations, specialty pharmacy fulfillment, inventory management, and co-pay or patient assistance programs
Track local commercial and Managed Medicaid policy determinations and relay market updates to internal launch teams
Train clinic staff to use the Patient Support Program Hub for benefits verification and prior authorization support
Collaborate with Field Sales, Key Account Managers, Patient Support Services, Compliance, Finance, Distribution, and Training
Prepare accounts for launch, mitigate billing uncertainties, accelerate time-to-treatment, and build confidence in reimbursement processes
Report to the Director of Retina Field Reimbursement

Requirements

What you’ll need

2+ years of direct experience executing buy-and-bill product launches in the specialty biologic or pipeline space
Prior experience in Ophthalmology/Retina highly preferred
Deep understanding of Medicare Part B, ASP models, Medicare Part D, commercial insurance, Medicaid, and specialized Hub reimbursement services
Ability to navigate a fast-paced product launch environment with evolving payer policies
Exceptional presentation skills and ability to explain complex financial/billing rules simply
Strong problem-solving skills for resolving rejected claims
Strict adherence to HIPAA, OIG guidance, and company compliance policies
Demonstrated success partnering in a matrixed environment
Extensive proficiency with Microsoft Office: Word, Excel, PowerPoint, Teams, and Outlook
Proficiency with CRM platforms
Approximately 50% travel, including overnight travel
Bachelor's degree required
6+ years of experience in the pharmaceutical/biotech industry, specifically in medical reimbursement, patient access, or field reimbursement
6+ years of experience supporting buy-and-bill products in ophthalmology, rare disease, or specialty pharmaceuticals preferred
Advanced degree or coding certification such as CPC, CHC, or PACs is a plus

Benefits

Comp & perks

Employer-paid medical, dental, and vision insurance
Paid time off (PTO)
Life and disability insurance
Paid parental leave
Competitive 401(k) company match
Flexible and entrepreneurial work environment
Inclusive culture
Opportunity to shape the future of the company