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 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 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. This is a remote & field-based role that covers the following territories: San Jose, CA, Fresno CA, East Bay, Walnut Creek CA. Associate must reside within territory, or within a reasonable daily commuting distance of 60 miles from territory border.

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.
• Address customer questions for issues related to NPC policies on therapeutic area product ordering, payment, inventorying, and product returns & replacement in offices.
• Work with key members of therapeutic area offices (e.g., providers, administrators, billing and coding staff, claims departments, revenue cycle managers) to support patient access to products.
• Analyze problems and offer solutions related to payer policies, drug acquisition and inventory management, and patient/practice reimbursement; identify trends and partner internally and externally to support patient pull-through.
• Support pull-through on local coverage decisions to enable meaningful patient access; proactively communicate policy changes or issues.
• Accountable for standing up NVS-sponsored patient support programs to enable patients starting and staying on therapy (e.g., Co-pay).
• Maintain expertise in regional/local access landscape and act as the reimbursement expert for aligned products as needed.
• Interface with Patient Support Center on patient case management, tracking cases, reimbursement support, and office staff education; review patient-specific information when 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 and handle PII in compliance with HIPAA and internal guidelines; identify and report adverse events per processes.

Buy and Bill Specific

• Assess access situation within 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.
• Educate stakeholders on logistics related to ordering, payment, inventory, and product returns/replacement.
• Analyze reimbursement issues and opportunities, acting as the designated 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 with NPC policies, laws, and regulations.

Education

Minimum Requirements: Bachelor’s Degree required; Advanced degree preferred.

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 distributors (buy and bill).
• Experience with coding, billing, and in-office support programs.
• Prior account management experience with complex accounts (payer landscape, high patient volume, large systems).
• Specialty pharmacy experience (ability to teach an office the entire process from script to injection).
• Experience building relationships within a practice to remove reimbursement barriers for specialty products.
• Knowledge of CMS policies and Medicare Parts B and D is a plus.
• Knowledge of Managed Care, Government, and Federal payer sectors and IDNs a plus.
• Ability to travel across large multistate geographies; 50%+ travel often required.
• Must live within assigned territory; driving is an essential function with a valid driver‚Äôs license.
• Experience with buy-and-bill reimbursement pathway and injection networks.

Preferred Qualifications

• Ability to manage multiple products
• Excellent presentation skills
• Advanced knowledge of medical insurance terminology
• Strong teamwork abilities
• Project management skills
• Ability to work independently
• Ability to manage expenses within budgets
• Good driving record
• Ability to schedule travel (air, hotel, rental car)
• Strong computer skills: PowerPoint, Excel, Word, CRM (Salesforce)
• Understanding of patient privacy laws including HIPAA and state laws
• Strong business acumen