Access & Reimbursement Manager

Job Description Summary

#LI-Remote

The Access & Reimbursement Manager, NPS- Allergy Seattle, WA geography. This is a remote & field-based role that covers the following, but not limited to: Washington, Oregon and Alaska. Associate must reside within territory, or within a reasonable daily commuting distance of 60 miles from territory

ARM will serve as the key contact and lead for access and reimbursement support-related matters and is responsible for being the local market access expert on payer policy coverage, multi-channel 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 proac-tively communicate changes in the healthcare landscape.

ARM will partner closely with other Novartis Pharmaceuticals Corporation (NPC) field associates, including Customer Engagement (Sales) and Market Access, representing NPC with the highest integrity in accord-ance with NPC Values and Behaviors. ARM will also be required to coordinate and communicate cross-functionally within NPC (e.g., Patient Support Center, Customer Engagement, Marketing, Market Access, Public Affairs, State & Government Affairs, Trade, Specialty Pharmacy Account Management, and other applicable third-party affiliates).

Job Description

Key Responsibilities:

• Interact within assigned accounts to support patient access within their therapeutic area product(s) providing proactive face-to-face education on product-specific programs to providers and staff in order to support integration of those programs into office processes and workflows.
• 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., Co-pay, 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 pull-through.
• 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 patient-specific 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 cross-functional 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).

Minimum Requirements:

• Minimum three to five years’ experience in public or private third-party 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 office support programs.
• Prior account management experience or prior experience with complex accounts (Payer landscape, high patient volume, large systems).
• Knowledge of Managed Care, Government, and Federal payer sectors, as well as Integrated Delivery Network/Integrated Health Systems.
• Ability to operate as a “team player” in collaborating with multiple sales representatives, sales leadership, and internal colleagues to reach common goals.
• Candidate must reside within territory, or within a reasonable daily commuting distance of X miles from the territory border. Ability to travel 60-80% over a broad geography is required, with the ability to drive and/or fly within the territory. Must have a valid driver’s license.

Preferred Qualification

• Experience working within Buy and Bill environments, including reimbursement and access support for provider-administered therapies.