Associate Director, Access & Reimbursement (SW)

Pharming Group; United States; Hybrid; USD 170,000 - 190,000; Full time

Benefits offered by this job

Flexible hybrid work schedule

Competitive compensation package

Annual target bonus

Long-term incentive program

401(k) plan with company match

Paid Time Off (PTO)

13 Company Holidays per year

Excellent benefit plans including医疗, 牙

Tuition reimbursement program

Health and wellness program

Job summary

Pharming is seeking an Associate Director, Reimbursement and Access (RAD) to support patient access and payer engagement across the U.S., with a focus on the Southwest region. You will drive coverage determinations, prior authorization strategies, and education for HCPs while collaborating with sales, case managers, and specialty partners.

This role requires extensive reimbursement know-how, cross-functional leadership, and the ability to navigate complex payer processes.

Qualifications

• Bachelor’s Degree from an accredited university.
• 3+ years’ experience as a Field Reimbursement Manager.
• 5+ years cross-functional experience in the pharmaceutical/biotech industry.
• 2+ Years' experience with prior authorization and multi-level appeals.

Responsibilities

• Handling all coverage, reimbursement and access needs across their territories/regions and work directly with their respective Sales Representatives, Hub Case Managers, National Account Directors (NADs) and customers (HCP facing).
• Work directly with Hub vendor to understand payer coverage issues and assist with prior-authorization (PA) denials and appeals by working with physicians and staff, helping prepare HCPs for Peer-to-Peer needs.
• Proactively track patients from submission of enrollment form through to shipment in order to identify potential issues and work to enable timely resolutions.
• Provide training and education to HCPs on payor specific coverage policies and authorization documentation requirements, appeals processes and patient financial assistance support programs.
• Develop and maintain positive working relationships with both internal team members (e.g., Sales Reps, NADs, Case Managers and Clinical Educators) and external stakeholders (e.g., physicians, office staff, Specialty Pharmacy partners).
• Work with HCPs and specialty pharmacy to overcome quantity limits or high dollar overrides.
• Escalate and engage the NAD when payer coverage or payment issues are identified, providing detailed specifics on issues, steps attempted to resolve, and identify key items that need addressing with the payer.
• Communicate issues and status with internal stakeholders and leaders (NADs, RBDs, VP of Sales).
• Communicate opportunities and challenges related to patient access issues to internal stakeholders.
• Work collaboratively to improve access and reimbursement tools and processes.
• Performs other duties as assigned.

Skills

Field Reimbursement

Cross-functional collaboration

PA & Appeals

Healthcare payer knowledge

Education

Bachelor's degree

Job description

Pharming is seeking an Associate Director, Reimbursement and Access (RAD) to support patient access and payer engagement across the U.S., with a focus on the Southwest region. You will drive coverage determinations, prior authorization strategies, and education for HCPs while collaborating with sales, case managers, and specialty partners.

This role requires extensive reimbursement know-how, cross-functional leadership, and the ability to navigate complex payer processes.