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Patient Access and Reimbursement Specialist
2 months ago
Position Overview:
As a Patient Access and Reimbursement Specialist, you will play a crucial role in facilitating patient access to our therapeutic products while ensuring a seamless reimbursement process. This position is designed for a dedicated professional who is passionate about improving patient outcomes through effective collaboration and education.
Key Responsibilities:
Your primary duties will include:
- Engaging with healthcare providers and staff within assigned accounts to deliver proactive education on product-specific programs, enhancing their integration into daily office workflows.
- Collaborating with essential personnel in therapeutic area offices, including providers, administrators, and billing staff, to ensure optimal patient access to our products.
- Analyzing reimbursement challenges and providing actionable solutions. You will need to understand payer policies, drug acquisition, and patient reimbursement intricacies, identifying trends and opportunities at various levels.
- Maintaining a comprehensive understanding of the local and regional access landscape, adapting to changes in healthcare regulations, and serving as a reimbursement expert for your designated therapeutic area.
- Working closely with cross-functional teams to share insights on customer needs and barriers related to access and reimbursement.
- Upholding NPC policies and compliance standards while handling Patient Identifiable Information (PII) in accordance with privacy laws.
Buy and Bill Responsibilities:
In this role, you will also be responsible for:
- Assessing access situations within your assigned territory and developing tailored Plans of Action (POA) to address specific needs.
- Establishing preferred acquisition pathways and educating stakeholders on the buy-and-bill process, including various acquisition scenarios.
- Providing insights on logistics related to ordering, payment, inventory management, and product returns.
- Identifying and addressing reimbursement issues while anticipating changes in the healthcare landscape.
- Engaging with non-prescribers, such as pharmacy staff and financial counselors, to facilitate patient access.
Qualifications:
To be successful in this role, you should possess:
- A Bachelor's Degree; an advanced degree is preferred.
- Three to five years of experience in reimbursement within the pharmaceutical industry or managed care.
- Experience with specialty pharmacy products and knowledge of coding and billing processes.
- Prior account management experience, particularly with complex accounts.
- Expertise in the buy-and-bill reimbursement pathway and established relationships within healthcare practices.
- Familiarity with CMS policies and processes, especially regarding Medicare Parts B and D.
- The ability to travel extensively within your assigned territory, with at least 50% travel required.
This position offers a unique opportunity to make a significant impact on patient access and reimbursement processes, ensuring that patients receive the care they need.
