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. The ARM serves as 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 account workflows. The role requires problem solving, analysis of access and reimbursement issues, and proactive communication of changes in the healthcare landscape. This is a remote and field-based role covering San Jose, CA, Fresno CA, East Bay, Walnut Creek CA; the associate must reside within the territory or within a reasonable daily commuting distance of 60 miles from the 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 to integrate those programs into office processes and workflows.
• Address customer questions on NPC policies related to therapeutic area product ordering, payment, inventorying, and product returns & replacement in offices.
• Collaborate with therapeutic area offices (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 (utilization management, denials, appeals), drug acquisition and inventory management, and patient/practice reimbursement; identify local, regional, and national reimbursement trends and partner internally/externally to support patient pull-through.
• Support pull-through on local coverage decisions and proactively communicate policy changes or issues affecting other departments.
• Stand 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 the Patient Support Center on patient case management, tracking, issue resolution, reimbursement support, and 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 ensure compliance with HIPAA and internal guidelines; handle PII appropriately.
• Identify and report adverse events via established Novartis systems as applicable.

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 and support buy-and-bill end-to-end processes and site pull-through, including centralized vs decentralized acquisition and channels like white/brown/clear bagging for administration.
• Educate stakeholders on logistics related to ordering, payment, inventory, and product returns/replacement.
• Analyze reimbursement issues and opportunities; act as the designated reimbursement expert for offices and field teams.
• Engage with non-prescribers (pharmacy, system leadership, financial counselors, office admins, revenue cycle managers, etc.).

Key Performance Indicators

• Meet and exceed designated corporate objectives.
• Customer satisfaction and awareness related to Novartis 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, managed care, clinical support, or pharmaceutical 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 or 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).
• Ability to establish relationships within a practice to remove reimbursement barriers for specialty products.
• Knowledge of CMS policies and processes (Medicare Parts B and D) is a plus; knowledge of managed care, government/federal payer sectors, and IDN/Integrated Health Systems is a plus.
• Ability to travel and cover large multistate geography; at least 50% travel required depending on geography and territory makeup. Must live within assigned territory. Driving is an essential function with a fully valid, unrestricted driver’s license required.
• Ability to work as a team with multiple sales reps, leadership, and internal colleagues.

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; manage expenses within budgets; good driving record.
• Ability to schedule travel; strong computer skills (PowerPoint, Excel, Word, CRM such as Salesforce.com); understanding of patient privacy laws including HIPAA.

Education

• Bachelor’s Degree required; advanced degree preferred.