Access and Reimbursement Senior Manager

Sumitomo Pharma Co., Ltd., is a global pharmaceutical company based in Japan with operations in the U.S. (Sumitomo Pharma America, Inc.), focused on addressing patient needs in oncology, urology, women's health, rare diseases, cell & gene therapies and CNS. With several marketed products and a diverse pipeline of early- to late-stage investigational assets, we aim to accelerate discovery, research, and development to bring novel therapies to patients sooner. For more information on SMPA, visit our website https://www.us.sumitomo-pharma.com or follow us on LinkedIn.

Job Overview:

This position reports to the Director, Access and Reimbursement and is part of the Market Access team, supporting SMPA’s Commercial Organization. This role serves as a field-based position responsible for supporting patient access to therapy by educating healthcare providers, office staff, health systems, and key stakeholders on reimbursement, coverage, coding, billing, and patient support programs. These roles serve as a subject matter expert on payer policies, access barriers, prior authorization requirements, claims adjudication, appeals processes, and patient affordability solutions, helping providers and staff navigate the complexities of obtaining appropriate patient access to prescribed therapies while maintaining compliance with all applicable legal, regulatory, and company standards. We are hiring four remote positions covering four main geographies: West, Central, Northeast and Southeast.

In this role, you will partner cross-functionally with Market Access, Account Management, Patient Services, Sales, Medical Affairs, Compliance, Legal, and Operations to identify and address reimbursement challenges that impact patient initiation, adherence, and continuity of care.

Essential Functions Required for Job

Reimbursement Education & Support 

• Serve as the field-based expert on reimbursement, coverage, coding, billing, claims submission, appeals, and patient access processes. 
• Educate healthcare providers, office managers, reimbursement specialists, and health system stakeholders on payer requirements and reimbursement pathways. 
• Provide compliant education regarding benefit verification, prior authorization requirements, appeal processes, coding updates, and coverage policies. 
• Assist providers in understanding patient support programs, affordability solutions, and HUB resources. 

Patient Access Strategy 

• Identify reimbursement and access barriers affecting patient treatment initiation and persistence. 
• Develop and execute territory-level access plans to address market-specific reimbursement challenges. 
• Monitor payer policy changes, coverage restrictions, utilization management criteria, and emerging reimbursement trends. 
• Collaborate with Market Access and Patient Services teams to improve the customer experience and patient journey. 

Customer Engagement 

• Build trusted relationships with physician practices, academic centers, integrated delivery networks, community providers, specialty pharmacies, and injection/infusion centers. 
• Deliver educational presentations regarding reimbursement processes and access support resources. 
• Respond to complex reimbursement inquiries and escalate unresolved issues through appropriate channels. 

Cross-Functional Collaboration 

• Partner with Corporate Account Directors, Regional Account Directors, Market Access Marketing, Patient Services, Trade, Medical Affairs, and Commercial leadership to identify systemic access issues and recommend solutions.
• Provide field insights related to payer coverage, claims trends, reimbursement obstacles, and customer needs. 
• Support product launches and new indication expansions through access readiness planning and field reimbursement education. 

Compliance & Governance 

• Ensure all activities are conducted in accordance with healthcare laws, industry guidance, corporate compliance policies, and applicable promotional/non-promotional standards.
• Maintain accurate activity documentation and reporting. 
• Participate in compliance and reimbursement training programs as required. 

Knowledge, Skills and Abilities (general & technical):

• Reimbursement Expertise
• Patient Access Strategy 
• Payer Landscape Knowledge 
• Provider Practice Operations
• External and Internal Customer Engagement, Empathy & Influence 
• Cross-Functional Leadership 
• Compliance Mindset 
• Business Acumen 
• Data Analysis & Insight Generation 
• Executive Communication 

Education & Experience Requirements:

• Bachelor’s degree in a related field required.
• Minimum 6 years of relevant experience in biotech or pharmaceutical industry with a background in in reimbursement, patient access, market access, patient services, account management, or a related healthcare field
• Deep understanding of commercial, Medicare, Medicaid, VA, and specialty pharmacy reimbursement environments. 
• Knowledge of medical and pharmacy benefit structures, prior authorization processes, coding systems, claims adjudication, and appeals pathways. 
• Demonstrated success collaborating with provider offices, health systems, specialty pharmacies, and patient support programs.
• Strong presentation, communication, relationship management, critical thinking and problem-solving skills. 
• Ability to travel extensively within assigned geography. 
• Preferred Qualifications:
• Specialty pharmaceutical, biotechnology, oncology, neurosciences, rare disease, immunology, or specialty therapeutic experience. 
• Experience launching specialty pharmaceutical products. 
• Knowledge of HUB operations, patient assistance programs, and affordability offerings. 
• Previous leadership or mentoring experience. 

Travel Requirements: 60-80% Travel Required

Mental/Physical Requirements:

• Extensive travel: Regular travel throughout assigned territory—estimated 60–80% of working time—requiring long periods on the road and flexible scheduling.  Overnight stays as part of business travel may be required depending on the territory.
• Mobility & stamina: Frequent in-person visits to physician offices, clinics, hospitals, and trade shows, requiring sustained driving, walking, standing, and sitting.
• Independent, field-based work: Ability to manage one’s schedule, work autonomously, and adapt to variable meeting locales (conference rooms, doctors’ offices, hotel spaces)
• Handling materials and samples: Transport of product samples, materials, and informational kits—lifting and carrying supplies between locations.
• Ability to lift 20 pounds.

This is an individual contributor role and does not have direct reports or formal people‑management responsibilities.

Travel Requirements:

60-80% Travel Required

Mental/Physical Requirements:

1. Extensive travel: Regular travel throughout assigned territory—estimated 60–80% of working time—requiring long periods on the road and flexible scheduling. Overnight stays as part of business travel may be required depending on the territory.

2. Mobility & stamina: Frequent in-person visits to physician offices, clinics, hospitals, and trade shows, requiring sustained driving, walking, standing, and sitting.

3. Independent, field-based work: Ability to manage one’s schedule, work autonomously, and adapt to variable meeting locales (conference rooms, doctors’ offices, hotel spaces)

4. Handling materials and samples: Transport of product samples, materials, and informational kits—lifting and carrying supplies between locations. Ability to lift 20 pounds.

The base salary range for this role is

Base salary is part of our total rewards package which also includes the opportunity for merit-based salary increases, short incentive plan participation, eligibility for our 401(k) plan, medical, dental, vision, life and disability insurances and leaves provided in line with your work state.  Our robust time-off policy includes flexible paid time off, 11 paid holidays plus additional time off for a shut-down period during the last week of December, 80 hours of paid sick time upon hire and each year thereafter.  Total compensation, including base salary to be offered, will depend on elements unique to each candidate, including candidate experience, skills, education and other factors permitted by law.

Disclaimer: The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.

Confidential Data: All information (written, verbal, electronic, etc.) that an employee encounters is considered confidential, in accordance with applicable law.

Compliance: Achieve and maintain Compliance with all applicable regulatory, legal and operational rules and procedures, by ensuring that all plans and activities for and on behalf of Sumitomo Pharma America (SMPA) and affiliates are carried out with the "best" industry practices and the highest ethical standards.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Drug Screening Requirements
Applicants for sales/field, manufacturing, or other designated roles will be required to submit to a pre-employment drug test.

Sumitomo Pharma America (SMPA) is an Equal Employment Opportunity (EEO) employer

Qualified applicants will receive consideration for employment without regard to race; color; creed; religion; national origin; age; ancestry; nationality; marital, domestic partnership or civil union status; sex, gender; affectional or sexual orientation; disability; veteran or military status or liability for military status; domestic violence victim status; atypical cellular or blood trait; genetic information (including the refusal to submit to genetic testing) or any other characteristic protected by law.

Sumitomo Pharma America (SMPA) endeavors to make its application process accessible to all. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact SMPA at reasonableaccomodations@us.sumitomo-pharma.com. This contact information is for accommodation requests only and cannot be used to inquire about the status of applications.