Key Responsibilities:
- Interact within assigned accounts to support patient access by providing proactive face-to-face (or virtual) education to providers and staff and integrating programs into office workflows.
- Use data and analytical tools to address questions related to payer policies and access requirements.
- Collaborate with key account members (providers, administrators, billing/coding staff, etc.) to support patient access.
- Answer questions on payer policies (utilization management, denials, appeals) and patient reimbursement.
- Partner with cross-functional teams to share insights on access and reimbursement needs and barriers.
- Maintain deep understanding of company policies/requirements and perform duties with integrity consistent with Values and Behaviors.
- Handle Patient Identifiable Information (PII) appropriately, ensuring compliance with HIPAA and internal privacy/compliance policies.
- Identify and report adverse events via established systems per applicable processes.
Qualifications:
- Minimum 8 years in the healthcare/pharmaceutical industry.
- Prior reimbursement or case management experience required (prior field access/reimbursement preferred).
- Experience with pharmacy benefit reimbursement/access and specialty pharmacy required.
- CPC or similar coding certification preferred.
- Experience in cardiometabolic area preferred.
- Knowledge of key Medicare policies (e.g., Part D design and IRA).
- Proven teamwork in highly matrixed, cross-functional teams.
- Travel as necessary (~50%); must live within assigned territory.
- Valid driver’s license required.