Access & Reimbursement Manager - Fort Worth, TX - Remote
The Access and Reimbursement Manager (ARM) is a 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.
The 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.
The 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. The 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).
Candidate must reside within territory, or within a reasonable daily commuting distance of 60 miles from territory border.
Major Accountabilities
- 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.
- 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). Identify 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).
- 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 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 HIPAA and other privacy laws and regulations and internal Company compliance guidelines).
Buy and Bill Specific
- 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, including scenarios of centralized and decentralized acquisition, and use of alternative channels such as white bagging, clear bagging, brown bagging, and alternate sites of care for administration.
- Accountable for engagement with non-prescribers, for example pharmacy, system leadership, financial counselors, office administrators, revenue cycle managers, etc.
Education
Bachelor’s Degree required. Advanced degree preferred.
- 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).
- Prior account management experience or prior experience with complex accounts (Payer landscape, high patient volume, large systems).
- Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare Parts B and D (Medical and Pharmacy Benefit design and coverage policy) a plus.
- Ability to operate as a "team player" in collaborating with multiple sales representatives, sales leadership, and internal colleagues to reach common goals.
- Ability to travel and cover large multistate geography territories, at least 50% travel required, based on geography and territory/targeting makeup.
Preferred Qualifications
- Advanced knowledge of medical insurance terminology.
- Understanding of patient privacy laws including HIPAA and similar state laws.
Why Novartis?
Novartis is committed to building an outstanding, inclusive work environment and diverse teams representative of the patients and communities we serve.
Accessibility and Reasonable Accommodations
Individuals in need of a reasonable accommodation due to a medical condition or disability for any part of the application process, or to perform the essential functions of a position, please send an e-mail to tas.nacomms@novartis.com or call +1 (877)395-2339 and let us know the nature of your request and your contact information. Please include the job requisition number in your message.
The pay range for this position at commencement of employment is expected to be between $136,800.00 to 205,200.00 a year; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, skills, and experience.
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