Access & Reimbursement Manager - CV - Miami (Remote)

Healthcare Businesswomen’s Association; United States; Remote; USD 138,000 - 258,000; Full time

Job summary

A leading healthcare organization in the United States is seeking an Access and Reimbursement Manager. This role requires expertise in patient access, reimbursement policies, and collaboration with various healthcare stakeholders. The ideal candidate has a Bachelor's degree, with advanced qualifications preferred, and a strong track record in providing education and support regarding healthcare access. The position offers a competitive salary and a dynamic work environment.

Qualifications

• Minimum three to five years in reimbursement or pharmaceutical industry.
• Experience with specialty pharmacy products.
• Knowledge of coding and billing processes.

Responsibilities

• Provide education on access and reimbursement topics.
• Analyze reimbursement issues and offer solutions.
• Collaborate with cross-functional associates.

Skills

Patient access support

Reimbursement expertise

Healthcare landscape analysis

Cross-functional collaboration

Problem-solving

Education

Bachelor’s Degree

Advanced degree

Tools

Salesforce.com

PowerPoint

Excel

Word

Job description

Overview

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 in support of aligned product strategy. The ARM serves 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. The ARM will problem solve, analyze access and reimbursement issues and opportunities, and proactively communicate changes in the healthcare landscape. The ARM will partner closely with NPC field associates, including Customer Engagement (Sales) and Market Access, and coordinate 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).

Major Accountabilities

• 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 to support integration of those programs into office processes and workflows.
• Address customer questions related to NPC policies on therapeutic area product ordering, payment, inventory, and product returns and replacements in offices.
• Work with key members of therapeutic area offices (e.g., providers, administrators, billing and coding staff, claims departments, revenue cycle managers) to support patient access to products.

• Analyze problems and offer solutions. Understand payer policies (utilization management, denials, appeals), drug acquisition and inventory management, and patient/practice reimbursement (e.g., co-pay, administration, drug claims). Analyze account reimbursement issues and opportunities. Identify trends at local, regional, and national levels and partner internally and externally to support patient pull-through.

• Support pull-through on local coverage decisions to enable patient access within the system. Proactively communicate policy changes or issues that could affect other departments.

• Responsible for standing up Novartis Vaccines and Diagnostics (NVS) sponsored patient support programs to enable patients starting and staying on therapy (e.g., co-pay).

• Maintain expertise in regional and local access landscape, anticipate changes in the healthcare landscape, and act as the aligned therapeutic area product(s) reimbursement expert as needed.

• Interface with Patient Support Center (hub) on patient case management, including tracking cases, issue resolution, reimbursement support, and education of appropriate office staff. Review patient-specific information in cases where the site has requested assistance and patient health information is available to resolve issues or coverage challenges.

• Collaborate with aligned cross-functional associates within NPC 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 responsibilities with integrity and in alignment with company guidance and Values and Behaviors. Handle patient identifiable information (PII) appropriately under HIPAA and other privacy laws and internal guidelines.

• Responsible for identifying and reporting adverse events via established Novartis systems as per applicable processes.

Buy and Bill Specific

• Assess access situation within the assigned geography and develop an appropriate Plan of Action (POA). Communicate POA to appropriate personnel.
• Establish preferred acquisition pathways. Educate on and support buy-and-bill end-to-end processes, workflows, and facility pull-through in complex accounts, including centralized and decentralized acquisition and use of alternative channels such as white bagging, clear bagging, brown bagging, and alternate sites of care for administration.
• Educate relevant stakeholders on logistics related to ordering, payment, inventory, and product returns and replacement.
• Analyze reimbursement issues and opportunities, anticipating changes in the healthcare landscape, and act as the designated reimbursement expert for offices and field teams.
• Engage with non-prescribers (e.g., pharmacy, system leadership, financial counselors, office administrators, revenue cycle managers) as needed.

Key Performance Indicators

• Responsible for meeting and exceeding designated corporate objectives.
• Overall customer satisfaction and awareness related to Novartis programs and access support, enabling customers to attain access to prescribed medicine (measured via indicators such as HCP completed start forms, Hub patient turnaround time, etc.).
• Adherence with NPC policies, laws and regulations.

Education

Bachelor’s Degree required. Advanced degree preferred.

Minimum Requirements

• Minimum three to five years of experience in public or private third-party reimbursement 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 (ability to teach an office the entire process from script to injection).
• Establishing relationships within a practice to help remove reimbursement barriers to specialty products for patients.
• Knowledge of CMS policies and processes with expertise in Medicare Parts B and D a plus.
• Knowledge of Managed Care, Government, and Federal payer sectors, as well as Integrated Delivery Network/Integrated Health Systems a plus.
• Ability to operate as a team player and collaborate with multiple sales representatives, sales leadership, and internal colleagues to reach goals.
• Ability to travel and cover large multistate geography territories (at least 50% travel) based on geography/territory.
• Residence within assigned territory. Driving is an essential function with a valid driver’s license required.
• Superb knowledge of buy-and-bill reimbursement pathway and experience working with injection networks.

Preferred Qualifications

• Ability to manage multiple products
• Excellent presentation skills
• Advanced knowledge of medical insurance terminology
• Strong teamwork abilities
• Project management skills
• Ability to work independently
• Ability to manage expenses within allocated budgets
• Good driving record
• Ability to schedule travel (air, hotel, rental car as needed)
• Above-average computer skills: PowerPoint, Excel, Word, CRM (Salesforce.com)
• Understanding of patient privacy laws including HIPAA and similar state laws
• Strong business acumen
• Ability to travel and possess a valid driver\'s license to drive to assigned healthcare accounts

Compensation

The pay range for this position at commencement of employment is expected to be between $138,600 and $257,400 per year. The salary range is effective from 1/1/25 through 12/31/25 and may be adjusted due to market factors. Final pay determinations depend on location, experience, knowledge, skills, and abilities. The total compensation may include a sign-on bonus, restricted stock units, discretionary awards, and a broad range of benefits (including 401(k) and paid time off). Details will be provided if an offer is made. This position is at-will and base salary and other compensation programs can be modified at any time.

The individual hired for this role will be required to complete initial training, including home study, in eight (8) or fewer hours per day and forty (40) or fewer hours per week.

EEO and Accessibility

EEO Statement: The Novartis Group of Companies are Equal Opportunity Employers. We do not discriminate in recruitment, hiring, training, promotion or other employment practices for reasons of race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, marital or veteran status, disability, or any other legally protected status.

Accessibility and reasonable accommodations: The Novartis Group of Companies are committed to providing reasonable accommodations to individuals with disabilities. If you need an accommodation for any part of the application process or to perform essential functions, email [e-mail] or call [phone] and include the job requisition number.