Access and Reimbursement Manager

The EMD Access and Reimbursement Manager (ARM) is responsible for executing the market access business plan pertaining to the assigned geography. Provider and account interface will be a key focus as the ARM has responsibilities to build relationships with, proactively educate, and ensure both providers and their staff are educated on payer and reimbursement policies and procedures, as well as providing expertise on patient support services. The ARM is responsible for uncovering and addressing patient specific issues that may prevent or slow a patient’s access. The ARM provides issue resolution through effective collaboration and coordination with all contracted specialty pharmacy and HUB regional leads and case managers. The ARM will also effectively work in collaboration with Field Sales, Sales Management, Patient Support Services, Managed Markets, Trade & Distribution, Payer Values and Outcomes, and internal commercial teams to achieve targeted objectives and meet established MBO’s and goals. Provider and account interface, prior authorization and coding education, as well as case management all will be done within current compliance guidelines. This position will also play a critical role in ensuring recently added institutional specialty pharmacies are appropriately onboarded and trained on all pertinent and relevant programs and services.

Territory covers: The entire State of New York

Essential Functions/Responsibilities

Essential duties and responsibilities may include all or some of the following:

· The ARM will implement strategies that achieve Business Unit and Corporate goals and objectives.

· Analyze Data and develop Action Steps.

· Establish and maintain strategic relationships with assigned providers and provider accounts.

· Educate and enhance awareness of patient access services and programs, as well as contracted channel distribution availability. Interact with all pertinent stakeholders to support patient access needs.

· Educate and ensure providers understand payer prior authorization requirements, appeals process, clinical criteria, and appropriate coding information.

· Demonstrate deep knowledge in reimbursement and access across many patient support programs and be the subject matter expert in the geography.

· Proactively address patient specific issues and provide issue resolution across the geography.

· Work closely with the external and internal customers to trouble shoot any specialty pharmacy related issues. Closely collaborate with the Specialty Pharmacy Account Directors (SPAD) to solve any customer related issues directly with the contracted specialty pharmacies. Onboard and train institutional specialty pharmacies as directed by SPADs.

· Ensure timely follow-up that demonstrates urgency to both the account and the patient.

• Collaborate and coordinate with regional sales teams to develop payer and reimbursement action plans for key provider accounts.
• Monitor, document, and communicate coverage policy and changes.
• Collaborate with internal and external partners to maintain a payer coverage and reimbursement database and communicate changes to field sales and sales management teams.
• Collaborates with Managed Markets to educate customers surrounding Commercial Payers, state Medicaid Agencies, Managed Medicaid Organizations, Healthcare Maintenance Organizations, Pharmacy Benefit Organizations, Health Care Plans, GPOs, DOD and Veterans Integrated Service Networks and other strategic healthcare entities specific to assigned initiatives and product requirements.
• Conduct annual business development reviews for corporate and ARM leadership, as well as required updates and reviews with assigned regional sales team(s).
• Provide managed care and reimbursement training and educational activities for internal and external stakeholders.
• Remain current on key managed care, reimbursement, and policy activities, as well as serve as an expert on business trends within key provider accounts.
• Ensure all pertinent information regarding current products, new products, competitive data, and overall information is brought to the attention of proper company personnel.
• Represent at various industry functions such as payer and reimbursement meetings, payer policy meetings, professional organization meetings, and other meetings as assigned.
• Demonstrates territory planning, priorities, and time management specific to geographical area of responsibility.
• Maintains accurate expenses within budget, timely and accurate completion of all reports, correspondence, and records as required.
• Execution of all activities within the defined regulatory and compliance program.
• Maintain company manuals, reports, computer systems, records, brochures, computers, and other equipment assigned to the position.

QUALIFICATIONS

· BA/BS Degree, and at least 5 years of pharma, biopharmaceutical, and/or medical device experience calling on field-based customers with demonstrated successful track record.

· Account Management and/or Reimbursement experience working in the provider office setting, building strong customer relationships.

· Experience working with HUB, Patient Services, and/or Specialty Pharmacy.

· Experience working with Integrated Health Systems-- preferred

· Managed Care and Reimbursement Knowledge –preferred

· Proven ability to thrive in both an independent setting and within a collaborative cross-functional team.

· Experience in building a team atmosphere with sales representatives, either with direct or indirect leadership authority.

· Excellent analytical skills focusing on patients and customers, uncovering business opportunities, and identifying trends and solutions.

· Ability to condense complex reimbursement issues into simple solutions.

· Ability to make sound decisions within time/resource constraints.

· Strong prioritization skills aligned with good strategic decision-making and problem-solving capabilities.

· Experience working with billing and medical claims personnel in healthcare settings preferred.

· Strong oral, written, and group communication skills.

· Ability to lead without authority.

· Proficient with MS Office including Excel, Word, PowerPoint preferred

· Candidates should live near a major airport and be willing and able to travel approximately 50% of the time (average 2-3 days per week).

Required/Preferred Education and Licenses

· BA/BS Degree (MBA preferred)

· CPC, or similar coding certification preferred, not required

· Prior Authorization Certification Specialist (PACS) preferred, not required