Access & Reimbursement Manager (ARM) NPS CV San Diego - Remote

Military, Veterans and Diverse Job Seekers; San Diego (CA); Remote; USD 110,000 - 140,000; Full time

Job summary

Military, Veterans and Diverse Job Seekers is seeking an Access & Reimbursement Manager (ARM) for the San Diego area with remote work option. This role focuses on enabling patient access and supporting buy-and-bill workflows across accounts, with a strong emphasis on payer policy navigation and collaboration with providers and staff.

The ARM will analyze reimbursement issues, educate stakeholders, and partner with cross-functional teams to remove barriers to specialty products while ensuring

Qualifications

• Minimum 3–5 years' experience in public or private third-party reimbursement or pharmaceutical industry.
• Experience with specialty pharmacy products and buy-and-bill processes.
• Experience with coding, billing and in-office support programs.
• Prior account management experience with complex payer landscapes.
• Specialty pharmacy experience and ability to teach offices the process from script to injection.
• CMS/Medicare Parts B and D knowledge a plus.
• Ability to travel ~50% across multistate territories.

Responsibilities

• Interact with assigned accounts to support patient access and educate providers and staff on programs and workflows.
• Collaborate with therapy-area offices and billing staff to support patient access to products.
• Analyze reimbursement problems, payer policies, and identify trends to drive account pull-through.
• Maintain expertise on regional access landscape and act as reimbursement expert for aligned products.

Skills

Reimbursement expertise

Payer policy knowledge

Provider education

Account management

Travel readiness

Education

Bachelor's degree

Job description

Access & Reimbursement Manager (ARM) NPS CV San Diego - Remote

Job Openings Access & Reimbursement Manager (ARM) NPS CV San Diego - Remote

About the job Access & Reimbursement Manager (ARM) NPS CV San Diego - Remote

Your Key Responsibilities:

• 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.
• 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.
• Ability to analyze problems and offer solutions. 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). Analyze account reimbursement issues & opportunities (as needed). Identifies trends at a local, regional and national level and partner with purpose internally and externally to support patient pull-through.
• 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).
• 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.
• 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. Handle Patient Identifiable Information (PII) appropriately (understand and ensure compliance with HIPPA and other privacy laws and regulations and internal Company compliance guidelines).

Buy and Bill Specific

• Assess access situation within the assigned geography and develop appropriate Plan of Action (POA). Communicate POA to appropriate personnel.
• Responsible for establishing preferred acquisition pathways. 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.
• Educates relevant stakeholders on logistics related to ordering, payment, inventory, and product returns & replacement.
• Analyze reimbursement issues & opportunities, anticipating changes in the healthcare landscape, and act as the designated reimbursement expert for offices and field teams.
• Accountable for engagement with non-prescribers, for example pharmacy, system leadership, financial counselors, office administrators, revenue cycle managers, etc.

What Youll Bring to the Role:
Education Bachelors Degree required. Advanced degree preferred.
Minimum Requirements

• Minimum three to five years' experience in public or private third-party Reimbursement arena or pharmaceutical industry in managed care, clinical support, or sales.
• Experience with specialty pharmacy products acquired through Specialty Pharmacy networks or specialty distributors (buy and bill)
• Experience with coding, billing and in office support programs
• Prior account management experience or prior experience with complex accounts (Payer landscape, high patient volume, large systems)
• Specialty pharmacy experience required (ability to teach an office the entire process from script to injection)
• Establishing relationships within a practice by working closely with them to help remove Reimbursement barriers to specialty products for their patients
• Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare Parts B and D (Medical and Pharmacy Benefit design and coverage policy) a plus
• Knowledge of Managed Care, Government, and Federal payer sectors, as well as Integrated Delivery Network/Integrated Health Systems a plus
• Ability to travel and cover large multistate geography territories, at least 50% travel required, based on geography and territory / targeting make up; Must live within assigned territory.
• Superb knowledge of buy-and-bill reimbursement pathway.
• Experience working with established injection networks.