Access & Reimbursement Manager (ARM) – NPS CV – Augusta - 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. And after a decade of decline, the number of deaths is on the rise again. 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 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.
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 (understand and ensure compliance with HIPAA and other privacy laws and regulations and internal Company compliance guidelines).
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, 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.
- Educates 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.
What You’ll Bring to the Role:
Education Bachelor’s Degree required. Advanced degree preferred.
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 (ability to teach an office the entire process from script to injection).
- Establishing relationships within a practice by working closely with them to help remove Reimbursement barriers to specialty products for their patients.
- 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.
- Knowledge of Managed Care, Government, and Federal payer sectors, as well as Integrated Delivery Network/Integrated Health Systems a plus.
- Ability to travel and cover large multistate geography territories, at least 50% travel required, based on geography and territory/targeting makeup; Must live within assigned territory.
- Superb knowledge of buy-and-bill reimbursement pathway.
- Experience working with established injection networks.
Why Novartis?
766 million lives were touched by Novartis medicines in 2021, and while we’re proud of this, we know there is so much more we could do to help improve and extend people’s lives. We believe new insights, perspectives and ground-breaking solutions can be found at the intersection of medical science and digital innovation. That a diverse, equitable and inclusive environment inspires new ways of working.
Commitment to Diversity & Inclusion: Novartis is committed to building an outstanding, inclusive work environment and diverse teams representative of the patients and communities we serve.
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