Field Reimbursement Manager - Central

Dendreon Pharmaceuticals; Kansas City (KS); On-site; USD 90,000 - 130,000; Full time

Job summary

Dendreon Pharmaceuticals seeks a Reimbursement Account Manager to ensure unimpeded patient access to PROVENGE across assigned regions. Develop and implement strategies to maximize growth, navigate national, regional, federal and state Medicaid policies to reduce barriers and improve reimbursement.

You will partner with physicians, payors, and practice leaders in oncology/urology to remove obstacles, educate on coverage and coding, and support the sales team.

Qualifications

• BA or BS degree required; MBA or advanced degree preferred.
• Minimum of 5 years’ experience in the pharmaceutical/biotech/life-sciences industry including 3-5 years healthcare coverage, coding, and/or reimbursement experience.
• Experience in oncology/urology specialty is preferred.
• Experience working in the buy and bill area of reimbursement is required.
• Must understand coding, coverage and reimbursement across all sites of care (community, academic, hospital, IDN).
• Broad knowledge of Medicare, Medicaid, Managed Care, Third Party payors.
• The RAM will cover multiple regions and thus significant overnight travel is required (estimated at 60%).

Responsibilities

• Removes practice reimbursement barriers by providing resources and creates access to PROVENGE, related to coverage and coding.
• Provides market place feedback in a timely manner to corporate leadership team on customer coverage and reimbursement trends, competitive updates and industry issues and opportunities.
• Educates providers on patient assistance programs and other resources.
• Updates and educates accounts on key Commercial and Government payor policies that may impact access to treatment with PROVENGE.
• Assists members of sales force in all aspects of PROVENGE coverage, coding and reimbursement, including access, pull-through, Key Opinion Leaders (KOL) and champion development as it relates to coverage, coding and reimbursement.
• Develops strategies for removing reimbursement barriers and effectively educates customers to increase reimbursement confidence.
• Serves as a resource to accounts and internal Dendreon staff regarding local, regional and national payor policies; reimbursement regulations and processes (i.e., eligibility and benefit verification, pre-authorization, billing, coding, claims, and appeals/grievances); practice management; Medicare and Medicaid rules and regulations; HIPAA.
• Acts as the liaison between LASH and internal/external customers on all aspect of coverage coding and reimbursement.
• Records all Regional Payor Provenge medical policies and contact information in SFDC.
• Complies with all OIG / FDA and corporate policies and procedures.

Skills

Healthcare reimbursement

Buy and bill reimbursement

Oncology/Urology knowledge

Education

BA or BS degree

MBA or advanced degree

Job description

CORE VALUES

• Put Patients First:Every day is an opportunity to improve the lives of those living with cancer.
• Act with Integrity:We commit to transparency, honesty, and always doing what’s right.
• Build Trust:Trust is earned through candid, open communication and a collaborative approach.
• Raise the Bar:We embrace continuous improvement and innovation, always striving to elevate our people.
• Drive Results:We are accountable to each other and deliver success together.

JOB SUMMARY

The Reimbursement Account Manager (RAM) is responsible for unimpeded patient access to Provenge within the assigned geographical area. The RAM will develop and implement strategies that will maximize business opportunities for growth. This position reviews national, regional, federal and state Medicaid payer policies to effectively reduce medical policy restrictions and practice reimbursement barriers. The RAM will effectively partner with medical practice decision makers, CFO’s, CEO’s, pharmacy and medical directors, purchasing departments, key stake holders within community-based urology and oncology practices along with academic and community based hospitals, medical centers, clinics, etc. to effectively remove reimbursement obstacles to PROVENGE utilization.

RESPONSIBILITIES

• Removes practice reimbursement barriers by providing resources and creates access to PROVENGE, related to coverage and coding.
• Provides market place feedback in a timely manner to corporate leadership team on customer coverage and reimbursement trends, competitive updates and industry issues and opportunities.
• Educates providers on patient assistance programs and other resources.
• Updates and educates accounts on key Commercial and Government payor policies that may impact access to treatment with PROVENGE.
• Assists members of sales force in all aspects of PROVENGE coverage, coding and reimbursement, including access, pull-through, Key Opinion Leaders (KOL) and champion development as it relates to coverage, coding and reimbursement.
• Develops strategies for removing reimbursement barriers and effectively educates customers to increase reimbursement confidence.
• Serves as a resource to accounts and internal Dendreon staffregardinglocal, regional and national payor policies; reimbursement regulations and processes (i.e., eligibility and benefit verification, pre-authorization, billing, coding, claims, and appeals/grievances); practice management; Medicare and Medicaid rules and regulations; HIPAA.
• Acts as the liaison between LASH and internal/external customers on all aspect of coverage coding and reimbursement.
• Records all Regional Payor Provenge medical policies and contact information in SFDC.
• Complies with all OIG / FDA and corporate policies and procedures.

JOB REQUIREMENTS

• BA or BS degree required. MBA or advanced degree preferred.
• Minimum of 5 years’ experience in the pharmaceutical/biotech/life-sciences industry including 3-5 years healthcare coverage, coding, and/or reimbursement experience required.
• Experience in oncology/urology specialty is preferred.
• Experience working in the buy and bill area of reimbursement is required.
• Must process an in-depth understanding of coding, coverage and reimbursement across all sites of care (community, academic, hospital, IDN) and the ability to apply this knowledge to address individual customer concerns.
• Broad knowledge of Medicare, Medicaid, Managed Care, Third Party payors is required.
• High level of sophistication/interpersonal skills needed to interact with Insurance Company Medical Directors, practice administrators, CEO, CFO, Pharmacy and practice Medical Directors.
• The Reimbursement Account Manager (RAM) will cover multiple regions and thus significant overnight travel is required, estimated at 60%.

Working Conditions and Physical Requirements

• Ability to sit or stand for extended periods of time
• Intermittent walking to gain access to work areas
• Finger dexterity sufficient to use a computer and to complete paperwork activities
• Vision sufficient to use a computer, to read written materials and to complete paperwork activities; Hearing sufficient to communicate with individuals by telephone and in person

As set forth in Dendreon Pharmaceuticals LLC’s Equal Employment Opportunity policy,we do not discriminate on the basis of any protected group status under any applicable law.