Access and Reimbursement Manager - CV - San Jose (Remote)

Role Summary

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 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 demonstrate problem solving and analysis of access and reimbursement issues and opportunities, and proactively communicate changes in the healthcare landscape. The ARM will partner closely with NPC field associates and coordinate cross-functionally within NPC. This is a remote & field-based role covering territory including San Jose, Fresno, East Bay, and Walnut Creek, CA; must reside within territory or within 60 miles of the territory border.

Responsibilities

• Interact within assigned accounts to support patient access by providing proactive face-to-face education on product-specific programs to providers and staff, integrating programs into office processes and workflows.
• Address questions related to NPC policies on product ordering, payment, inventorying, and returns in offices.
• Collaborate with providers, administrators, billing and coding staff, claims departments, and revenue cycle managers to support patient access to products.
• Analyze reimbursement issues and opportunities, understand payer policies, drug acquisition and inventory management, and patient/practice reimbursement; identify local/regional/national trends and partner to support patient pull-through.
• Support pull-through on local coverage decisions to enable patient access; communicate policy changes or issues affecting other departments.
• Stand up NPC-sponsored patient support programs (e.g., Co-pay) to enable patients starting and staying on therapy.
• Maintain expertise in regional/local access landscape and act as the reimbursement expert for aligned products as needed.
• Interface with the Patient Support Center on patient case management, tracking, issue resolution, and education of office staff; review patient-specific information as requested.
• Collaborate with cross-functional NPC teams to share insights on customer needs and barriers related to access and reimbursement.
• Maintain understanding of NPC policies, handle patient identifiable information (PII) in compliance with HIPAA and internal guidelines.
• Identify and report adverse events via established Novartis systems.

Buy and Bill Specific

• Assess access in the geography and develop a Plan of Action (POA); communicate POA to appropriate personnel.
• Establish preferred acquisition pathways; educate on buy-and-bill end-to-end processes and facility pull-through in complex accounts, including centralized/decentralized acquisition and alternative channels (white bagging, clear bagging, brown bagging, etc.).
• Educate stakeholders on logistics related to ordering, payment, inventory, and returns/replacements.
• Analyze reimbursement issues and opportunities; act as the reimbursement expert for offices and field teams.
• Engage with non-prescribers (pharmacy, system leadership, financial counselors, office administrators, revenue cycle managers, etc.).

Key Performance Indicators

• Meet and exceed designated corporate objectives.
• Overall customer satisfaction and awareness related to NPC programs and access support; enable customers to attain access to prescribed medicine.
• Adherence to NPC policies, laws, and regulations.

Qualifications

• Minimum three to five years' experience in public or private third-party reimbursement, or pharmaceutical industry in managed care, clinical support, or sales.
• Experience with specialty pharmacy products via Specialty Pharmacy networks or specialty distributors (buy and bill).
• Experience with coding, billing, and in-office support programs.
• Prior account management experience or experience with complex accounts (payer landscape, high patient volume, large systems).
• Specialty pharmacy experience; ability to teach offices the entire process from script to injection.
• Ability to build relationships within practice to remove reimbursement barriers for patients.
• Knowledge of CMS policies and processes, Medicare Parts B and D a plus.
• Knowledge of managed care, government, federal payer sectors, and IDN/Integrated Health Systems a plus.
• Team-oriented with ability to collaborate across multiple stakeholders.
• Ability to travel multi-state territories; travel required (at least 50%). Must live within assigned territory.
• Driving is an essential function with a valid, unrestricted driver's license; accommodations available if driving is restricted by medical condition.
• Proficiency in buy-and-bill reimbursement pathway and injection networks.

Education

• Bachelor‚Äôs Degree required; advanced degree preferred.

Preferred Qualifications

• Ability to manage multiple products
• Excellent presentation skills
• Advanced knowledge of medical insurance terminology
• Strong teamwork and project management skills
• Ability to work independently and manage expenses within budgets
• Good driving record and ability to schedule travel
• Proficiency in PowerPoint, Excel, Word, CRM (Salesforce)
• Understanding of patient privacy laws including HIPAA
• Strong business acumen and willingness to travel with a valid driver's license