Access & Reimbursement Manager, Cardiovascular - Central IL & St Louis MO Territory - Remote

Role Summary

Remote and field-based role that educates defined accounts on access and reimbursement topics to support product strategy. Serves as the local market access expert on payer policy coverage, reimbursement processes, and integration of manufacturer programs into account workflows. Collaborates with NPC field teams and cross-functional partners to address payer policies, access barriers, and patient pull-through. Territory includes Springfield, IL; Peoria, IL; Champagne, IL; Bloomington, IL; and St. Louis, MO; candidate must reside within the territory or within a reasonable daily commuting distance.

Responsibilities

• Interact within assigned accounts to support patient access within their therapeutic area products, providing proactive education on product-specific programs to providers and staff and integrating those programs into office processes and workflows.
• Address questions related to NPC policies on ordering, payment, inventory, and returns/replacement.
• Work with providers, administrators, billing/coding staff, claims departments, and revenue cycle managers to support patient access to products.
• Analyze problems and offer solutions related to payer policies (utilization management, denials, appeals), drug acquisition and inventory management, and patient/practice reimbursement; identify local trends and partner to support patient pull-through.
• Support pull-through on local coverage decisions to enable meaningful patient access and proactively 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 the regional/local access landscape and act as the reimbursement expert for their therapeutic area product(s).
• Interface with the Patient Support Center on patient case management, including tracking cases, reimbursement support, and staff education; review patient-specific information as requested to resolve issues.
• Collaborate with cross-functional NPC associates to share insights on customer needs and barriers related to access and reimbursement.
• Maintain a strong understanding of NPC policies and ensure compliance with privacy and company guidelines when handling patient information.

Buy and Bill Specific

• Assess access situations in the assigned geography and develop a Plan of Action; communicate the POA to appropriate personnel.
• Establish preferred acquisition pathways and educate on buy-and-bill end-to-end processes, including centralized/decentralized acquisition and alternative channels such as white bagging, clear bagging, and brown bagging.
• Educate stakeholders on logistics related to ordering, payment, inventory, and product returns/replacement.
• Analyze reimbursement issues and opportunities, acting as the designated reimbursement expert for offices and field teams.

Qualifications

• Bachelor’s Degree required; Advanced degree preferred.
• 3–5 years' experience in public or private third-party reimbursement or pharmaceutical industry in managed care, clinical support, or sales.
• Experience with specialty pharmacy products acquired through 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 required (ability to teach an office the entire process from script to injection).
• Establishing relationships within a practice to help remove reimbursement barriers to specialty products for patients.
• Knowledge of CMS policies and processes with expertise in Medicare Parts B and D (a plus).
• Knowledge of Managed Care, Government, and Federal payer sectors, as well as Integrated Delivery Network/Integrated Health Systems (a plus).
• Superb knowledge of buy-and-bill reimbursement pathway.
• Experience working with established injection networks.
• Strong ability to work as part of a cross-functional team and to communicate complex reimbursement concepts clearly.
• Strong organization and problem-solving skills with attention to detail.

Additional Requirements

• Residence within the territory or within a reasonable daily commuting distance (up to 60 miles) from the territory border.
• Ability to travel across a large multistate geography; travel may be required up to 50% or more depending on geography and targeting.
• Driving is an essential function of this role; a fully valid and unrestricted driver's license is required.