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 key contact and lead for access and reimbursement support-related matters and is 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. This role requires problem solving, analysis of access and reimbursement issues, and proactive communication of changes in the healthcare landscape. The ARM partners with NPC field associates and coordinates cross-functionally within NPC. This is a remote and field-based role covering San Jose, CA; Fresno, CA; East Bay, and Walnut Creek, CA. Associate must reside within territory or within a 60-mile daily commuting distance 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 programs into office workflows.
• Address customer questions related to NPC policies on product ordering, payment, inventory, and returns in offices.
• Work with therapeutic area office staff (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, inventory management, and patient/practice reimbursement; identify local/regional/national reimbursement trends and collaborate 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, reimbursement support, and staff education; review patient-specific information as requested to resolve issues.
• Collaborate with cross-functional NPC colleagues to share insights on customer needs and barriers related to access and reimbursement.
• Maintain understanding of NPC policies and ensure compliance with privacy laws and internal guidelines; handle patient identifiable information appropriately.
• Identify and report adverse events per established processes.

Buy and Bill Specific

• Assess access in the geography and develop a Plan of Action (POA); communicate POA to relevant 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 alternate sites of care.
• Educate stakeholders on logistics for ordering, payment, inventory, and 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 administrators, revenue cycle managers, etc.).

Key Performance Indicators

• Meet and exceed designated corporate objectives.
• Increase customer satisfaction and awareness of NPC programs and access support; enable patients to access prescribed medicine.
• Adhere to NPC policies, laws, and regulations.

Education

• 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 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 an office the entire process from script to injection).
• Ability to develop relationships within a 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 and federal payer sectors, and IDN/Integrated Health Systems a plus.
• Team-oriented with the ability to collaborate with multiple sales representatives and internal colleagues.
• Ability to travel across a large multistate geography; at least 50% travel required; must live within the assigned territory.
• Driving is an essential function; must possess a fully valid and unrestricted driver’s 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 travel with a valid driver’s license