Access & Reimbursement Manager (ARM) – NPS CV – Manhattan -Remote
For six decades, we’ve been working to advance cardiovascular health by transforming the standard of care and bringing innovation to areas of high unmet need.
CVD is the #1 cause of death worldwide. In fact, CVD is responsible for more deaths than all cancers combined. Evidence suggests the pandemic led to the worsening of CV outcomes. This burden is likely to escalate and overwhelm society if we do not make significant changes to curtail the rising incidence. ASCVD accounts for 85% of CVD deaths and addressing key risk factors – such as elevated LDL-C and Lp(a) – can reduce the risk of heart attack and stroke.
Job Purpose:
The Access & Reimbursement Manager (ARM) is a remote/field-based role that proactively provides in person (or virtual as needed) education to defined accounts within their assigned geographies on a wide range of access and reimbursement topics and needs in support of aligned product(s) strategy. 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 proactively 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 accordance 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).
Your 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.
- 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., 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.
- 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).
- Collaborate with aligned cross-functional associates within NPC 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.
Buy and Bill Specific:
- 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 buy-and-bill end-to-end processes, workflows, and facility pull-through in complex accounts.
- Educate 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 non-prescribers, for example pharmacy, system leadership, financial counselors, office administrators, revenue cycle managers, etc.
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 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.
- Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes.
- Ability to travel and cover large multistate geography territories, at least 50% travel required.
- Superb knowledge of buy-and-bill reimbursement pathway.
Why Novartis?
766 million lives were touched by Novartis medicines in 2021. We believe new insights, perspectives and ground-breaking solutions can be found at the intersection of medical science and digital innovation.
Diversity and Inclusion:
The Novartis Group of Companies are Equal Opportunity Employers and take pride in maintaining a diverse environment.
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