Access and Reimbursement Manager-MS (Multiple Sclerosis)-Texas North- Remote

Role Summary

The Access and Reimbursement Manager, MS (Multiple Sclerosis) – Texas North (Remote) is a field-based role responsible for payer policy coverage, reimbursement, and patient access across the assigned territory. The role delivers in-person or virtual education to providers and staff on access programs, serves as the local market access expert, and integrates manufacturer support programs into office workflows. The position partners with NPC field teams and cross-functional colleagues to anticipate changes in the healthcare landscape and resolve coverage barriers to enable patients starting and staying on therapy.

Responsibilities

• Interact within assigned accounts to support patient access, 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 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 appropriately support patient access to products.
• Ability to analyze problems and offer solutions. Understand specifics and support questions associated with payer policies (e.g., utilization management, denial, and appeals), drug acquisition and inventory management, and patient / practice reimbursement (e.g., Co-pay, administration, drug claims). Analyze account reimbursement issues & opportunities. Identify trends at a local, regional and national level and partner internally and externally to support patient pull-through.
• Supports pull-through on local coverage decisions to enable meaningful patient access within the system. Proactively communicate policy changes or issues that could potentially affect other departments.
• Accountable for standing up NPC-sponsored patient support programs to enable patients starting and staying on therapy (i.e., Co-pay).
• Maintain expertise in regional and local access landscape, anticipating changes in the healthcare landscape, and act as their aligned therapeutic area product(s) reimbursement expert (as needed).
• Interface with Patient Support Center (hub) on important matters related to patient case management, including tracking cases, issue resolution, reimbursement support, and appropriate office staff education. Review patient-specific information in cases where the site has specifically requested assistance and patient health information is available in resolving any issues or coverage challenges.
• Collaborate with aligned cross-functional associates within NPC to share insights on customer needs and barriers for their aligned therapeutic area product(s) related to access and reimbursement.
• Maintain a deep understanding of NPC policies and requirements and perform all responsibilities with integrity and in a manner consistent with company guidance and prescribed Values and Behaviors. Handle Patient Identifiable Information (PII) appropriately and ensure compliance with HIPAA and other privacy laws and regulations.
• Responsible for identifying and reporting adverse events via the established Novartis systems as per applicable processes.

Qualifications

• Required: Bachelor’s Degree required. Advanced degree preferred.
• Required: Minimum three to five years' experience in public or private third-party Reimbursement arena or pharmaceutical industry in managed care, clinical support, or sales.
• Required: Experience with specialty pharmacy products acquired through Specialty Pharmacy networks or specialty distributors (buy and bill).
• Required: Experience with coding, billing and in-office support programs.
• Required: Prior account management experience or prior experience with complex accounts (Payer landscape, high patient volume, large systems).
• Required: Specialty pharmacy experience required (ability to teach an office the entire process from script to injection).
• Required: Establishing relationships within a practice by working closely with them to help remove reimbursement barriers to specialty products for their patients.
• Required: Knowledge of Centers for Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare Parts B and D (Medical and Pharmacy Benefit design and coverage policy) a plus.
• Required: Knowledge of Managed Care, Government, and Federal payer sectors, as well as Integrated Delivery Network/Integrated Health Systems a plus.
• Required: Ability to operate as a "team player" in collaborating with multiple sales representatives, sales leadership, and internal colleagues to reach common goals.
• Required: Ability to travel and cover large multistate geography territories, at least 50% travel required, based on geography and territory/targeting makeup.
• Required: Must live within assigned territory.
• Preferred: Ability to manage multiple products.
• Preferred: Excellent presentation skills.
• Preferred: Advanced knowledge of medical insurance terminology.
• Preferred: Strong teamwork abilities.
• Preferred: Project management skills.
• Preferred: Ability to work independently.
• Preferred: Ability to manage expenses within allocated budgets.
• Preferred: Above average computer skills: PowerPoint, Excel, Word, CRM (Salesforce.com).
• Preferred: Understanding of patient privacy laws including HIPAA and similar state laws.
• Preferred: Strong business acumen.
• Preferred: Ability to travel and possess a valid driver's license to drive to assigned healthcare accounts, unless otherwise specified.

Education

• Bachelor’s Degree required; Advanced degree preferred.

Additional Requirements

• Travel: Demonstrated ability to travel across large multistate geographies as assigned (minimum 50% travel).
• Driving: Driving is an essential function; must have a valid and unrestricted driver’s license to perform the role.