Access & Reimbursement Manager (ARM) - Renal - Minneapolis (Remote)

Role Summary

Access and Reimbursement Manager (ARM) is a field-based role that educates defined accounts on access and reimbursement topics to support product strategy. The ARM serves as the local market access expert on payer coverage, billing and coding, claims processing, reimbursement, and integration of manufacturer programs into account workflows, while problem solving and communicating changes in the healthcare landscape. This remote/field role covers Minneapolis, MN, North Dakoda, South Dakoda and Colorado; the associate must reside within the territory or within a 60-mile 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, integrating those programs into office processes and workflows.
• Address customer questions for issues related to NPC policies on product ordering, payment, inventorying, and 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) in order 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 (as needed). Identifies trends at a local, regional and national level and partner with purpose 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 NVS-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 (see above) 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 (understand and ensure compliance with HIPPA and other privacy laws and regulations and internal Company compliance guidelines).
• Responsible for identifying and reporting adverse events via the established Novartis systems as per applicable processes.

Qualifications

• 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.
• 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: Establishing relationships within a practice by working closely with them to help remove Reimbursement barriers to specialty products for their patients.
• Preferred: Knowledge of Centers of 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.
• Preferred: Knowledge of Managed Care, Government, and Federal payer sectors, as well as Integrated Delivery Network/Integrated Health Systems a plus.
• Required: Ability to travel and cover large multistate geography territories, at least 50% travel required, based on geography and territory / targeting make up.
• Required: Must live within assigned territory.
• Required: Driving is an essential function of this role, meaning it is fundamental to the purpose of this job and cannot be eliminated. Because driving is an essential function of the role, you must have a fully valid and unrestricted driver’s license to be qualified for this role.
• Preferred: Ability to work as a team player and collaborate with multiple stakeholders; strong communication skills.

Skills

• Excellent presentation skills.
• Advanced knowledge of medical insurance terminology.
• Strong teamwork abilities.
• Project management skills.
• Ability to work independently.
• Ability to manage expenses within allocated budgets.
• Good driving record; ability to operate in a field setting.
• Proficiency with PowerPoint, Excel, Word, and CRM (Salesforce.com).
• Understanding of patient privacy laws including HIPAA and state regulations.
• Strong business acumen.
• Ability to schedule and coordinate work-related travel (air, hotel, rental car).

Education

• Bachelor’s Degree required; Advanced degree preferred.

Additional Requirements

• Travel: Ability to travel and cover large multistate geography; at least 50% travel required depending on geography and territory.
• Residency: Must reside within the assigned territory, or within a 60-mile commuting distance from the territory border.
• Driving: Driving is an essential function; must have a fully valid and unrestricted driver’s license.
• Accommodations: The company provides reasonable accommodations for qualified individuals with medical restrictions if accommodation can be provided without eliminating the essential function of driving.