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

Role Summary

Access & Reimbursement Manager (ARM) is a field-based role that proactively provides in-person or virtual education to defined accounts within assigned geographies on a wide range of access and reimbursement topics to support product strategy. The ARM serves as the local market access expert on payer policy coverage, multi-channel acquisition pathways, billing and coding, claims processing, and reimbursement, integrating 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 teams and cross-functional stakeholders and must reside within the assigned territory (remote coverage possible) including Minneapolis, MN, North Dakota, South Dakota and Colorado.

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 in order to support integration of 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) 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.

Skills

• 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 allocated budgets.
• Good driving record.
• Ability to schedule individual work-related travel (air, hotel, rental car as needed).
• Above average computer skills: PowerPoint, Excel, Word, CRM (Salesforce.com).
• Understanding of patient privacy laws including HIPAA and similar state laws.
• Strong business acumen.
• 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 up to 50% or more, depending on geography.
• Driving is an essential function; must have a fully valid and unrestricted driver's license.
• Must reside within the assigned territory or within a reasonable commuting distance (e.g., 60 miles).