Access & Reimbursement Manager, Immunology Columbia, SC (Remote)
Offer summary
Qualifications:
Bachelor’s Degree required; advanced degree preferred., Minimum three to five years' experience in reimbursement or pharmaceutical industry., Experience with specialty pharmacy products and buy-and-bill processes., Knowledge of CMS policies, managed care, and payer sectors..Key responsibilities:
- Support patient access by educating providers and staff on product programs.
- Analyze reimbursement issues and support office workflows for access and billing.
- Interface with patient support and cross-functional teams to resolve coverage challenges.
- Develop and communicate plans to optimize access and reimbursement in assigned territories.
Job description
Job Description Summary
ARM will serve as the key contact and lead for access and reimbursement supportrelated matters and is responsible for being the local market access expert on payer policy coverage, multichannel acquisition pathways, billing and coding, claims processing, reimbursement, and integration of manufacturer support programs into a range of account workflows. Additionally, the ARM will continually need to demonstrate a keen ability to problem solve, analyze access and reimbursement issues and opportunities, and proactively communicate changes in the healthcare landscape.
Job Description
Major Accountabilities
- Interact within assigned accounts to support patient access within their therapeutic area product(s) providing proactive facetoface education on productspecific programs to providers and staff in order to support integration of those programs into office processes and workflows.
- Address customer questions for issues related to NPC policies on therapeutic area product ordering, payment, inventorying, and product returns & replacement in offices.
- Work with key members of therapeutic area offices (e.g., providers, administrators, billing and coding staff, claims departments, revenue cycle managers) in order to appropriately support patient access to products.
- Ability to analyze problems and offer solutions. Understand specifics and support questions associated with payer policies (e.g., utilization management, denial, and appeals), drug acquisition and inventory management, and patient practice reimbursement (e.g., Copay, administration, drug claims). Analyze account reimbursement issues & opportunities (as needed). Identifies trends at a local, regional and national level and partner with purpose internally and externally to support patient pullthrough.
- Supports pull through on local coverage decisions to enable meaningful patient access within the system. Proactively communicate policy changes or issues that could potentially affect other departments.
- Accountable for standing up NVSsponsored patient support programs to enable patients starting and staying on therapy (i.e., Copay).
- Maintain expertise in regional and local access landscape, anticipating changes in the healthcare landscape, and act as their aligned therapeutic area product(s) reimbursement expert (as needed).
- Interface with Patient Support Center (hub) on important matters related to patient case management, including tracking cases, issue resolution, reimbursement support, and appropriate office staff education. Review patientspecific information in cases where the site has specifically requested assistance and patient health information is available in resolving any issues or coverage challenges.
- Collaborate with aligned crossfunctional associates within NPC (see above) to share insights on customer needs and barriers for their aligned therapeutic area product(s) related to access and reimbursement.
- Maintain a deep understanding of NPC policies and requirements and perform all responsibilities with integrity and in a manner consistent with company guidance and prescribed Values and Behaviors. Handle Patient Identifiable Information (PII) appropriately (understand and ensure compliance with HIPPA and other privacy laws and regulations and internal Company compliance guidelines).
- Assess access situation within the assigned geography and develop appropriate Plan of Action (POA). Communicate POA to appropriate personnel.
- Responsible for establishing preferred acquisition pathways. Educate on and support buyandbill endtoend processes, workflows, and facility pullthrough in complex accounts, including scenarios of centralized and decentralized acquisition, and use of alternative channels such as white bagging, clear bagging, brown bagging, and alternate sites of care for administration.
- Educates relevant stakeholders on logistics related to ordering, payment, inventory, and product returns & replacement.
- Analyze reimbursement issues & opportunities, anticipating changes in the healthcare landscape, and act as the designated reimbursement expert for offices and field teams.
- Accountable for engagement with nonprescribers, for example pharmacy, system leadership, financial counselors, office administrators, revenue cycle managers, etc.
- Responsible for meeting and exceeding designated corporate objectives.
- Overall customer satisfaction and awareness related to Novartis programs and access support. Enables customers (measured via HCP submitted completed start forms, Hub patient TAT, etc.) to successfully attain access to prescribed medicine
- Adherence with NPC policies, laws and regulations.
- Minimum three to five years experience in public or private thirdparty Reimbursement arena or pharmaceutical industry in managed care, clinical support, or sales.
- Experience with specialty pharmacy products acquired through Specialty Pharmacy networks or specialty distributors (buy and bill)
- Experience with coding, billing and in office support programs
- Prior account management experience or prior experience with complex accounts (Payer landscape, high patient volume, large systems)
- Specialty pharmacy experience required (ability to teach an office the entire process from script to injection)
- Establishing relationships within a practice by working closely with them to help remove Reimbursement barriers to specialty products for their patients
- Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare Parts B and D (Medical and Pharmacy Benefit design and coverage policy) a plus
- Knowledge of Managed Care, Government, and Federal payer sectors, as well as Integrated Delivery NetworkIntegrated Health Systems a plus
- Ability to operate as a team player in collaborating with multiple sales representatives, sales leadership, and internal colleagues to reach common goals
- Ability to travel and cover large multistate geography territories, at least 50% travel required, based on geography and territory targeting make up.
- Must live within assigned territory.
- Superb knowledge of buyandbill reimbursement pathway.
- Experience working with established injection networks.
- Ability to manage multiple products
- Excellent presentation skills
- Advanced knowledge of medical insurance terminology
- Strong teamwork abilities
- Project management skills
- Ability to work independently
- Ability to manage expenses within allocated budgets
- Good driving record
- Ability to schedule individual workrelated travel (air, hotel, rental car as needed)
- Above average computer skills: PowerPoint, Excel, Word, CRM (Salesforce.com)
- Understanding of patient privacy laws including HIPAA and similar state laws
- Strong business acumen
- Ability to travel and possess a valid drivers license to drive to assigned healthcare accounts, unless otherwise specified
EEO Statement:
The Novartis Group of Companies are Equal Opportunity Employers. We do not discriminate in recruitment, hiring, training, promotion or other employment practices for reasons of race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, marital or veteran status, disability, or any other legally protected status.
Accessibility and reasonable accommodations
The Novartis Group of Companies are committed to working with and providing reasonable accommodation to individuals with disabilities. If, because of a medical condition or disability, you need a reasonable accommodation for any part of the application process, or to perform the essential functions of a position, please send an email to us.reasonableaccommodations@novartis.com or call +1(877)3952339 and let us know the nature of your request and your contact information. Please include the job requisition number in your message.
Salary Range
$138,600.00 $257,400.00
Skills Desired
Access And Reimbursement Strategy, Analytical Skill, Analytical Thinking, CrossFunctional Work, CustomerCentric Mindset, Employee Development, Finance, GotoMarket Strategies, Healthcare Policies, Healthcare Sector Understanding, Health Economics, Health Technology Assessment (HTA), Innovation, Inspirational Leadership, Market Access Strategies, Negotiation, People Management, Process Management, Public Affairs, Real World Evidence (RWE), Regulatory Compliance, Risk Management, Speed and Agility Training, Value Propositions, Waterfall Model
Preferred Qualifications:
Education
Bachelor’s Degree required. Advanced degree preferred.
Minimum Requirements
Key Performance Indicators
Buy and Bill Specific
Required profile
Experience
Hard Skills
Other Skills
- Analytical Skills
- Negotiation
- People Management
- Analytical Thinking
- Learning Agility
- Innovation
- Good Driving Record
- Teamwork
- Presentations
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