Job Summary
- Design, develop, and deliver comprehensive training programs for Market Access teams to support healthcare providers, navigate payer landscapes, and address reimbursement challenges.
- Lead training interventions at national and regional levels; provide classroom-based education to enhance organization-wide capabilities.
Key Responsibilities
Become a Subject Matter Expert
- Understand reimbursement environment, distribution models, commercial payers/PBMS, Medicare, Medicaid, and related systems/processes/policies/trends.
- Apply technical knowledge of patient insurance benefit design, coverage, coding/payment methodologies, prior authorizations, appeals, new drug exception process, patient affordability, and medical/pharmacy benefit designs.
- Educate teams on current reimbursement environment and anticipated changes.
- Know traditional and wholesale/retail and specialty distribution; support navigation of scripts through specialty pharmacy networks.
- Understand customer structures/processes, stakeholder roles, electronic health records systems, and manufacturer support programs.
Training Program Development
- Create training curricula covering reimbursement processes, payer policies, patient access programs, and case management.
- Develop training materials (presentations, job aids, workshops, e-learning, case studies).
- Adapt programs for regional payer variations and product-specific requirements.
- Coach, evaluate, and certify specialist readiness.
Training Delivery & Ongoing Updates
- Train new hires and Market Access Managers (in-person and virtual) on payer access, prior authorizations, appeals, and patient support programs.
- Provide hands-on exercises to help providers resolve reimbursement and patient access issues.
- Provide updates on industry trends, payer policy changes, and new access programs; run refresher/update sessions.
Market Access Support & Collaboration
- Observe/assess performance to identify skill gaps; provide coaching and feedback.
- Troubleshoot complex reimbursement issues.
- Collaborate across legal/compliance/sales/product/market access teams to align training with strategies and product launches.
Compliance & Reporting
- Ensure training aligns with healthcare laws/regulations (e.g., HIPAA, CMS) and internal policies.
- Track/report training progress and knowledge retention; document activities and ensure certification/compliance.
Qualifications
- Bachelorβs degree or equivalent experience in healthcare/business/education (advanced degrees/certifications such as CPC or CMRS a plus).
- Extensive experience in healthcare reimbursement, market access training/roles; strong payer policy, coding/billing, and patient access knowledge.
- Training/education experience (preferably pharma/biotech/medical device).
- In-depth knowledge of reimbursement workflows (insurance verification, prior authorization, appeals, payer nuances).
- Excellent presentation/facilitation; strong problem-solving and coaching skills.
- Willingness to travel up to 50%.