Access and Reimbursement Manager, Immunology

3 weeks ago

Hartford, Connecticut, United States Novartis Group Companies Full time
Job Description Summary

The Access and Reimbursement Manager, Immunology is a remote/field-based role that covers the following, but not limited to: Connecticut, Rhode Island and Southern Massachusetts.

Candidate must reside within territory, or within a reasonable daily commuting distance of 60 miles from territory border.

About the Role:

The Access and Reimbursement Manager (ARM) is a field-based role that proactively provides in person (or virtual as needed) education to defined accounts within their assigned geographies on a wide range of access and reimbursement topics and needs (see below) in support of aligned product(s) strategy.

The ARM will serve as the key contact and lead for access and reimbursement support-related matters and is responsible for being the local market access expert on payer policy coverage, multi-channel acquisition pathways, billing and coding, claims processing, reimbursement, and integration of manufacturer support programs into a range of account workflows.

Additionally, the ARM will continually need to demonstrate a keen ability to problem solve, analyze access and reimbursement issues and opportunities, and proactively communicate changes in the healthcare landscape.

The ARM will partner closely with other Novartis Pharmaceuticals Corporation (NPC) field associates, including Customer Engagement (Sales) and Market Access, representing NPC with the highest integrity in accordance with NPC Values and Behaviors.

The ARM will also be required to coordinate and communicate cross-functionally within NPC (e.g., Patient Support Center, Customer Engagement, Marketing, Market Access, Public Affairs, State & Government Affairs, Trade, Specialty Pharmacy Account Management, and other applicable third-party affiliates).

Key Responsibilities:
  1. Interact within assigned accounts to support patient access within their therapeutic area product(s) providing proactive face-to-face education on product-specific programs to providers and staff in order to support integration of those programs into office processes and workflows.
  2. Address customer questions for issues related to NPC policies on therapeutic area product ordering, payment, inventorying, and product returns & replacement in offices.
  3. Work with key members of therapeutic area offices (e.g., providers, administrators, billing and coding staff, claims departments, revenue cycle managers) in order to appropriately support patient access to products.

The ARM will analyze problems and offer solutions. The ARM will understand specifics and support questions associated with payer policies (e.g., utilization management, denial, and appeals), drug acquisition and inventory management, and patient / practice reimbursement (e.g., Co-pay, administration, drug claims).

The ARM will analyze account reimbursement issues & opportunities (as needed). The ARM will identify trends at a local, regional and national level and partner with purpose internally and externally to support patient pull-through.

The ARM will support pull through on local coverage decisions to enable meaningful patient access within the system. The ARM will proactively communicate policy changes or issues that could potentially affect other departments.

The ARM will be accountable for standing up NVS-sponsored patient support programs to enable patients starting and staying on therapy (i.e., Co-pay).

The ARM will maintain expertise in regional and local access landscape, anticipating changes in the healthcare landscape, and act as their aligned therapeutic area product(s) reimbursement expert (as needed).

The ARM will interface with Patient Support Center (hub) on important matters related to patient case management, including tracking cases, issue resolution, reimbursement support, and appropriate office staff education.

The ARM will review patient-specific information in cases where the site has specifically requested assistance and patient health information is available in resolving any issues or coverage challenges.

The ARM will collaborate with aligned cross-functional associates within NPC (see above) to share insights on customer needs and barriers for their aligned therapeutic area product(s) related to access and reimbursement.

The ARM will maintain a deep understanding of NPC policies and requirements and perform all responsibilities with integrity and in a manner consistent with company guidance and prescribed Values and Behaviors.

The ARM will handle Patient Identifiable Information (PII) appropriately (understand and ensure compliance with HIPPA and other privacy laws and regulations and internal Company compliance guidelines).

The ARM will be responsible for identifying and reporting adverse events via the established Novartis systems as per applicable processes.

Buy and Bill Specific:

The ARM will assess access situation within the assigned geography and develop appropriate Plan of Action (POA). The ARM will communicate POA to appropriate personnel.

The ARM will be responsible for establishing preferred acquisition pathways.

The ARM will educate on and support buy-and-bill end-to-end processes, workflows, and facility pull-through in complex accounts, including scenarios of centralized and decentralized acquisition, and use of alternative channels such as white bagging, clear bagging, brown bagging, and alternate sites of care for administration.

The ARM will educate relevant stakeholders on logistics related to ordering, payment, inventory, and product returns & replacement.

The ARM will analyze reimbursement issues & opportunities, anticipating changes in the healthcare landscape, and act as the designated reimbursement expert for offices and field teams.

The ARM will be accountable for engagement with non-prescribers, for example pharmacy, system leadership, financial counselors, office administrators, revenue cycle managers, etc.

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