Associate Director, Market Access & Reimbursement- Northern California

Role Summary

The Associate Director of Market Access and Reimbursement (ADMAR) is responsible for serving as the primary field-based contact for education, assistance and issue resolution for healthcare providers (HCPs) and sites of care with respect to patient access and reimbursement for Sarepta’s products. The territories this role will support consist of Northern California and Oregon. This role requires fundamental level of knowledge in the market access and reimbursement journey encompassing procurement, payer policies and coverage, benefit design, prior authorizations, appeals, exceptions, denials, coding and payer payment guidelines, site of care regulation/requirements, understanding of coding guidelines (CPT/J-Code/ICD-10), commercial and/or statutory pricing structures or mandates as reflected by Medicare/Medicaid requirements with demonstrated knowledge of the complex regulatory environment. The ADMAR utilizes account management skills and a strong business acumen to strategically implement site readiness and site engagement activities, including phasing, on boarding and assessing site of care readiness/operational efficiency to minimize access barriers for patients and providers. The ADMAR works closely with Patient Services, Educational Support Managers, Payer Access and Trade/Distribution colleagues and serves as the subject matter expert on access and reimbursement to the internal organization.

Responsibilities

• Educate HCPs and sites of care on prior authorization/reauthorization process, assist with the navigation of the denial/appeal process and with product procurement through buy-and-bill and limited distribution network; understands miscellaneous product codes and administration codes as well as the introduction of specific J-codes to assist with claims submissions.
• Expand knowledge of reimbursement landscape eventually being able to identify barriers hindering patient access and educate HCPs of this process for prescribed Sarepta therapies.
• Build expertise to analyze, monitor and triage situations which may adversely impact patient access to therapy and assist in resolving distribution access challenges.
• Partner with SareptAssist Case Manager to navigate the Specialty Pharmacy communication and utilize critical thinking to strategically identify/prevent access and reimbursement issues where possible.
• Responsible for understanding and upholding Sarepta‚Äôs Legal and Compliance guidance at a customer and field leadership level related to access, cost and reimbursement issues.
• Build relationships through consistent communication and collaboration with internal and external stakeholders while delivering valuable reimbursement support and information to help providers facilitate the patient access journey for their DMD families for approved Sarepta therapies.

Site Readiness/Engagement

• Identify and profile sites of care and key stakeholders within given territory and initiate discussions with key stakeholders and evaluate operational effectiveness at each site.
• Utilize unconventional thinking to validate and gain a deep understanding of site capabilities, identify gaps and develop gap resolution plans; determine the processes in place and possible actions focused on site capacity, equipment, and additional resource needs.
• Engage with C-suite leadership, administration, revenue cycle management, finance, managed care team, contracting, pharmacy, PA departments and care team and deliver presentations on FDA approved label for Sarepta products, product procurement options, and pricing information to minimize barriers to patient access.
• Support HCP champion through formulary inclusion/decision process and monitor Pharmacy and Therapeutic Committee timelines to confirm site readiness.
• Facilitate ongoing communication with sites sharing best practices through constant dialogue from both a clinical and commercial expertise focusing on retraining needs and challenge resolution.
• Exhibits willingness to make informed decisions working efficiently and effectively ensuring timely access to Sarepta products for identified patients.

More About You

• Bachelor‚Äôs degree (BA/BS) from an accredited school required, MBA preferred
• 10 years of relevant experience with 5-8 years of field experience in biotech industry, reimbursement experience preferred.
• Key account management, sales management, account management and/or rare disease product launch experience in Neuromuscular, Pediatric Neurology, Oncology, or other specialty experience in biotech, including launch experience in rare disease space preferred
• Basic knowledge and understanding of compliance with HIPPA and OIG guidance in the rare disease space
• Hospital finance, claims processing, and/or billing/coding experience preferred
• Ability to learn and eventually navigate the complex payer landscape including a deep understanding of access and payer approval process for prescribed Sarepta therapies with a deep understanding of payer policies for our products
• Primary understanding of the PA process, denial management, product acquisition via the specialty pharmacy, buy-and-bill, IV infusion coding and reimbursement within multiple sites of care
• Understands both the buy-and-bill process and specialty Pharmacy networks, managed care, benefit design, government payers and their impact on product access with excellent working knowledge of evolving market access and reimbursement landscape
• Knowledge of infused-biologic therapies for chronic, rare diseases
• Self-driven individual looking to excel in a high pace Market Access/Reimbursement environment with excellent time management and organizational skills
• Capability to adapt to changing business needs and conditions while working with a variety of situations, individuals, groups and varying customer needs; including ability to utilize technologies to work in a virtual setting when travel is restricted
• Ability to listen to others and communicate cross-functionally in an effective manner to overcome access obstacles
• Demonstrates willingness to collaborate with internal colleagues and the ability to influence others
• Valid driver‚Äôs license and in good standing
• Ability to travel up to approximately 60% when living within the assigned geographic region