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 serves as the key contact and 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 will coordinate cross-functionally within NPC and partner with field associates, and must reside within the territory or within 60 miles of the territory border.

Responsibilities

• Interact within assigned accounts to support patient access, providing proactive face-to-face education on product-specific programs to providers and staff and integrating those programs into office processes.
• Address customer questions related to NPC policies on product ordering, payment, inventorying, and returns in offices.
• Work with providers, administrators, billing and coding staff, claims departments, and revenue cycle managers to support patient access to products.
• Analyze problems and offer solutions regarding payer policies, drug acquisition and inventory management, and patient/practice reimbursement; identify trends and collaborate to support patient pull-through.
• Support local coverage decisions to enable patient access; communicate policy changes or issues affecting other departments.
• Stand up NPC-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.
• 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 HIPAA and privacy compliance; 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, workflows, and facility pull-through, including centralized/decentralized acquisition and alternate channels of care.
• 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 with NPC policies, laws, and regulations.

Education

Minimum Requirements

• Bachelor‚Äôs Degree required; Advanced degree preferred.
• 3‚Äì5 years in public/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 build 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, Federal payer sectors a plus.
• Team-oriented with ability to collaborate across multiple areas; willingness to travel roughly 50%+; must live in assigned territory; driving is an essential function with a valid license.
• Experience with buy-and-bill reimbursement pathway; injection networks.

Preferred Qualifications

• Ability to manage multiple products.
• Excellent presentation skills; advanced medical insurance terminology knowledge.
• Strong teamwork, project management, and independent work abilities.
• Ability to manage expenses within budgets; good driving record; ability to schedule travel.
• Strong computer skills (PowerPoint, Excel, Word, CRM like Salesforce); understanding of HIPAA and patient privacy laws; strong business acumen.