Access & Reimbursement Manager

Summary:

In this contracted, field-based role, the Access & Reimbursement Manager will serve as a dedicated access and reimbursement resource within an assigned territory. The ARM will support appropriate patient access by educating provider offices on payer requirements, reimbursement processes, patient support services, and approved access resources. This role will be highly visible within the organization and responsible for providing education to targeted healthcare providers and office staff, which may include primary care, cardiology, and other client-defined specialties or account types, regarding access services and reimbursement solutions specific to the product and therapeutic area. (Cardiovascular).

Additional responsibilities include:

• Manage daily activities that support appropriate patient access to our client’s products in the provider offices and work as a liaison to other patient assistance and access support services offered by our clients.
• Expert in providing general education on Retail and Specialty Pharmacy drug Prior Authorizations, Appeals, and Denials
• Provide in-person customer visits.
• Participate in client meetings as appropriate. Participate in regularly scheduled internal team and cross-functional meetings and calls. Input call activity into customer CRM, as appropriate.
• Serve as the local access and reimbursement expert for the assigned geography, monitoring payer policy, formulary coverage, utilization management requirements, pharmacy access pathways, prior authorization trends, denial patterns, and other access barriers. Communicate relevant changes and field insights to appropriate internal stakeholders in a timely and compliant manner. Provide office education and awareness during the entire access process which may include formulary coverage/utilization management criteria, coding, insurance forms & procedures, benefits investigation, prior authorization, appeal, and/or claims resolution.
• Use only client-approved materials, messaging, processes, and resources when engaging with healthcare providers, office staff, and field partners.
• Identify and communicate field access insights, payer trends, office workflow barriers, and reimbursement challenges to appropriate internal stakeholders to support continuous improvement
• Recognize and report adverse events, product complaints, and other reportable information in accordance with client policy and applicable requirements.

Desired Job Requirements:

• 3+ years of experience in one or more of the following areas: Managed Care, Field Reimbursement, Patient Services, and/or Sales (Specialty or Biologics), or healthcare provider office practice management
• 4-year degree in related field or equivalent experience
• Cardiovascular/Cardiology and Hospital Healthcare Systems experience a plus
• The ability to travel 3-4 days a week, with overnights (as needed), must reside within the Territory
• Solution oriented mindset, strong business acumen, & strong analytic capabilities
• Experience and understanding of Retail Pharmacies & Specialty Pharmacies
• Demonstrated ability to educate offices on access processes and issue resolution
• Experience educating HCPs and office staff on client specific Patient Service programs (i.e. copay)
• Experience delivering educational presentations in person and/or via technology platforms such as Zoom, Webex, and/or Teams
• Advanced knowledge of medical insurance terminology
• Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare (Part D for Pharmacy Benefit products)
• Proven ability to develop and maintain trusted relationships with internal partners and effectively work well in teams
• Ability to manage ambiguity & problem solve
• Prepare and submit appropriate expense reports in a timely fashion
• Valid Driver’s License