Position Summary:
The Access & Reimbursement Manager (ARM) will be a subject matter expert on access & reimbursement for FILSPARI (Sparsentan), working remotely within their assigned geography to provide education and case-specific support to internal and external stakeholders including but not limited to health care providers (HCPs) and sales force within their assigned region. The Access & Reimbursement Manager must have extensive expertise in navigating insurance and access related barriers and will be a highly collaborative individual who proactively manages multiple priorities in a fast-paced environment (e.g., fielding daily questions from sales team, working with Hub, specialty pharmacy partners, and office contacts to move patients through the reimbursement process, accurately updating daily reports). Preference will be given to candidates residing in or near North New Jersey; however, candidates living anywhere within the territory will be considered.
Responsibilities:
Proactive Office Support Throughout FILSPARI Onboarding Process:
- Access & Reimbursement Manager (ARM), serves as the key contact responsible for patient access and reimbursement in an assigned geography that provides appropriate support to providers and professional staff.
- Cultivate the highest level of expertise in the FILSPARI onboarding process, from Patient Start Form (PSF) submission through REMS enrollment to reimbursement.
- Walk offices through what to expect from the FILSPARI onboarding process, either when a new PSF comes in or when an opportunity for re-education is identified.
- Educate physicians and physician practices on the full FILSPARI onboarding process, including how to complete the PSF, how to enroll patients and physicians in REMS, requirements for prior authorization approvals, appeal approvals, and specific medical policy steps to obtain reimbursement.
- Closely monitor cases as they progress through the onboarding process.
Escalated Support for Specific Cases:
- Proactively identify and solve complex patient access issues by working across the Hub, HCP offices and communicating with field team. Educate physicians (in-person or virtual) on escalated reimbursement issues.
- Assist physicians and office staff when PSFs or REMS enrollment forms are submitted with information missing; coordinate with Hub and REMS Administrator partners to be able to clearly explain to the office what information is missing.
- Assist physicians and office staff in resolving access issues (prior authorization, appeals, denials, letters of medical necessity, REMS), and help ensure appropriate education to avoid future reimbursement hurdles.
- Effectively partner with reimbursement stakeholders (specialty pharmacy, sales team, HCP office, REMS administrator, etc.) to communicate challenges, identify solutions, and ensure the patient is progressing through the reimbursement process.
- Understand specifics and support questions associated with PSF submission, REMS enrollment, payer policies (e.g., PAs process and denial, and appeals), patient reimbursement (e.g., Co-pay, PAP), reimbursement issues & opportunities (as needed).
Sales Force Communication / Partnership:
- Proactively seek out timely and regular updates on case statuses, leveraging network of reimbursement stakeholders.
- Periodically ride with and educate sales force on complexities surrounding the pharmaceutical reimbursement process. Maintain a level of expertise on specific payors and the requirements for claim approvals.
- Log calls and notes within standardized platform daily, to provide clear and concise updates that drive toward action and emphasize next steps and owners (based on standardized template).
- Lead weekly case status update meetings with sales force and sales leadership in a way that demonstrates confidence and preparedness and emphasizes specific next steps / owners.
- Coordinate with Hub, specialty pharmacies, and REMS administrator stakeholders to regularly share information and work together to move cases forward efficiently and smoothly.
- Balance daily tasks and schedule to accommodate ad-hoc communication from the sales force and sales leadership without delays to other ARM priorities.
- Operate in compliance with HIPAA within program guidelines.
Proactive Trend Identification and Key Account Education:
- Deliver expertise in regional and local access landscape, anticipating changes in the healthcare landscape, and act as the Subject Matter Expert for FILSPARI onboarding, including reimbursement.
- Know your business to identify trending barriers to reimbursement within your geography, then create quarterly business plan to address these barriers.
- Bring forth opportunities / proposals for HCP office education, then work collaboratively with sales counterparts to develop and execute strategy.
- Work with market access team to monitor national and regional payer trends and changes, then educate both internal (sales) and external (HCPs) on changes.
Education/Experience Requirements:
- Bachelor’s degree in related field required. Equivalent combination of education and applicable job experience may be considered.
- 5+ years in pharmaceutical / health industry working with Hubs, payers, HCPs or related area
- 3+ years reimbursement / access / case management experience
- Specialty pharmaceutical, nephrology, rare disease, REMs experience preferred.
Additional Skills/Experience:
- The ideal candidate will embody Travere’s core values: Courage, Community Spirit, Patient Focus and Teamwork.
- Experience in managing access complexities associated with a new to market medication.
- Prior account management experience or prior experience with complex accounts (Payer landscape, government payer, VA).
- Experience with specialty pharmacy products / products acquired through Specialty Pharmacy networks or specialty distributors (buy and bill).
- Proven ability to build relationships with HCPs, office staff, sales team, and Hub counterparts.
- Comprehensive understanding of private/commercial insurance reimbursement, government payer Medicare Part D, VA, etc.
- Demonstrated experience in helping to educate on reimbursement processes (inc. foundational knowledge of benefit verifications, prior authorization, appeals, denials, letters of medical necessity, pre-determination requirement.
- Computer skills (basic Excel, PowerPoint, etc.).
- Ability to resolve issues / educate virtually (within access & reimbursement / case management).
- Well organized with the ability to multitask, prioritize, and manage shifting responsibilities in a dynamic, cross-functional teamwork environment.
- Excellent collaboration skills with strong attention to detail and the ability to multi-task and manage complexity.
- Strong interpersonal and organizational skills and excellent verbal and written communication skills are required.
- The position is field based and the candidate must live in their territory or immediate adjacency.
- Flexibility to travel as needed (up to 35%).
- The ability to perform face to face work with customers, colleagues and/or onsite in San Diego, and the ability to satisfactorily meet credentialling requirements for access to healthcare facilities and customer sites within your territory on an ongoing basis, are essential job functions of this position.
Total Rewards Offerings:
Travere provides comprehensive total rewards offerings that demonstrate our commitment as a diverse, equitable, people-centric, and pay-for-performance organization.
Benefits:
Our benefits include premium health, financial, work-life and well-being offerings for eligible employees and dependents, wellness and employee support programs, life insurance, disability, retirement plans with employer match and generous paid time off.
Compensation:
Our competitive compensation package includes a combination of both cash compensation (base pay and short-term incentive) and long-term incentive compensation (company stock), designed to recognize, retain, and reward employees.
