Jodie Carusotto BSN, RN, PACS
Attleboro,MA
Summary
Field Reimbursement Manager with a background in nursing and Dedicated to Patient outcomes. Accomplished history in supporting Buy and Bill and specialty pharmacy products for multiple disease states and multiple sites of care. knowledgeable in billing and coding, claims reviews prior authorizations and appeals. Experienced in commercial/private payer, Medicare and medicaid structure systems and reimbursement process. Skillful at Building and fostering relationships with many cross functional teams
Overview
15
15
years of professional experience
Work History
Field Reimbursement Manager
Syneos Health-Ferring Pharmaceuticals
09.2022 - Current
- Launched first in class, rare disease product through Medical benefit.
- Manage Medicare/Medicaid/Commercial access and reimbursement pull through for buy and bill rare disease product in key Northeast accounts.
- Educate offices on payor policies, onboarding requirements (ICD-10, J-code, CPT, HCPCS, CMS 1500/1450) specialty distributors, submitting and correcting claims.
- Support office with information to assist with prior authorization appeals/denials and Claims as well as copay and patient assistance programs.
- Manage HUB and case managers, specialty pharmacy's as well as specialty distributors to support product.
- Work cross functionally and collaboratively with Sales, market access, national account manager.
- Provide weekly payor analysis for Northeast regional Managers and Market access lead.
- Participate in workflow projects including HUB enhancement, reporting and case manager training.
- Support Multiple High-volume Centers of excellence and President Club Winners
Field Reimbursement Manager
Novartis Pharmaceuticals
03.2020 - 07.2022
- Provide HCP office support on reimbursement by coordinating with key account players and matrix team members.
- Pivotal in training local offices to convert from faxing start forms to electronic submission platform.
- Proactive in live and virtual office education on Novartis-approved access tools and start form requirements.
- Participate in strategic account management with internal partners to develop regional business plans
- Support reimbursement journey from prescriber decision through access, PAs, appeals and denials.
- Educate key office members on patient assistance programs, support services and web-based provider programs
- Provide offices information on regional and local formulary wins and payer challenges.
- Identify and remove access barriers for patients working with Cover My Meds and Alongside MS.
- Facilitated cross-functional meetings to discuss impact of policy changes on reimbursement process, ensuring clear understanding among all stakeholders.
Field Reimbursement Manager
Syneos Health-Novartis
02.2018 - 03.2020
- Launched first in class Neurology Biologic injectable
- Provided HCP office support on reimbursement and access as well as prior authorization and denial requirements.
- Educated offices on HCP portal for cover my meds and electronic submission of start form.
- Participated in strategic account management with internal partners to develop regional business plans
- Supported reimbursement journey from prescriber decision through access, PAs, appeals and denials
- Educated key office members on patient copay, free trial, patient assistance programs, and HCP portal.
- Provide offices information on regional and local formulary wins and payer challenges.
- Identify and remove access barriers for patients through direct work with hubs: Cover My Meds (Alongside MS)
- Collaborate with Regional Manager to share insights into potential barriers and access solutions within local accounts
- Identify market access trends in territory to enable appropriate patient access and pull through
- Proactive and reactive managing through conflict and barriers to coverage
- Maintained PHI and HIPPA compliance regulations with role clarity.
Field Access Specialist
Teva Pharmaceuticals
07.2017 - 02.2018
- Successfully launched Psychiatry and Neurology product on northeast team.
- Provided high touch support to offices for onboarding, access, PAs, appeals and denials
- Delivered approved disease state education to HCPs/support staff on dosing, writing process, and payor requirements
- Spoke at out-of-office speaker programs to address key opinion leaders and answer access questions
- Assisted Matrix team with prescription process and pull through
- Identified and removed patient access barriers using patient adherence programs and HUB
Education
Bachelor of Science - Nursing
Florida Atlantic University
Boca Raton, FL12.1999
Skills
- Buy and Bill,
- Specialty pharmacy
- Neurology, Rheumatology, Oncology
- Biologic's and Rare Disease
- Billing and Coding, CPT, HCPCS
- HIPAA Compliance
- Utilization review
- Medicare/Medicaid
- Claims Processing
Timeline
Field Reimbursement Manager
Syneos Health-Ferring Pharmaceuticals
09.2022 - Current
Field Reimbursement Manager
Novartis Pharmaceuticals
03.2020 - 07.2022
Field Reimbursement Manager
Syneos Health-Novartis
02.2018 - 03.2020
Field Access Specialist
Teva Pharmaceuticals
07.2017 - 02.2018
Bachelor of Science - Nursing
Florida Atlantic University