Field Reimbursement Director - Ohio Valley (Ohio, Western PA)

Role Summary

Field Reimbursement Director will optimize access to Alnylam products in the Ohio Valley region by understanding and addressing reimbursement and patient access challenges. The role delivers educational, reimbursement in-service programs to sites of care and leads action plans to resolve access issues. The candidate will build relationships with external stakeholders at strategic accounts and leverage extensive knowledge of buy-and-bill products and high-touch, specialty products.

Responsibilities

• Optimizes access to the full Alnylam portfolio of products by ensuring provider accounts understand access and reimbursement dynamics
• Proactively identifies trends impacting barriers to access or reimbursement and creates solutions
• Works with internal stakeholders and providers to support treatment pathways for patients
• Engages with key stakeholders in accounts, including Intake/Authorization teams, billing compliance, Finance executives, Infusion Center management and decision-makers and key Pharmacy Stakeholders
• Responsible for identifying, addressing and resolving outstanding claim payment issues
• Provides guidance to case managers on case-specific complex PA/Appeal issues
• Collaborates with case managers on treatment site finding for the specialty business when there are no site of care options available in the treatment directory
• Provides case-specific PA/Appeal support and site of care options for the rare business
• Maintains relationships with Medicare Administrative Contractors (MACs) to optimize coverage for Alnylam therapies and monitors LCDs and NCDs
• Works with Public Policy & Government Relations on engagement strategies regarding MACs or local policy changes and state-level public policy initiatives
• Utilizes reporting dashboards to track critical metrics and KPIs
• Ensures compliance with all corporate and industry policies in collaboration with Legal, Regulatory and Compliance

Qualifications

• Bachelor‚Äôs degree required
• 10+ years prior pharma/biotech experience
• 5+ years of field reimbursement experience in buy-and-bill, preferably in rare disease or oncology
• Established relationships with MACs highly preferred
• Strong knowledge of the US payer landscape
• Deep understanding of medical and pharmacy benefit across payer types and sites of care
• Proven ability to identify access and reimbursement barriers and design effective resolution plans
• Exceptional communication, interpersonal and problem-solving skills for interaction with decision makers
• Ability to lead without authority in a collaborative, fast-paced environment
• Self-starter with alignment to core values and a passion for rare disease
• Ability to travel up to 75%
• Must reside in geography with proximity to a mid-size or larger airport

Skills

• Relationship management with payers and providers
• Strategic planning and execution
• PA/Appeal management and case support
• Data analysis and KPI tracking
• Regulatory and compliance awareness

Education

• Bachelor‚Äôs degree required

Additional Requirements

• Travel up to 75% required