Access & Reimbursement Manager, Immunology

This is a fully remote position, open to applicants in United States.

📋 Description

• The ARM will act as the primary contact and leader for matters related to access and reimbursement support, serving as the local market access authority on payer policy coverage, multi-channel acquisition pathways, billing and coding, claims processing, reimbursement, and the integration of manufacturer support programs into various account workflows.

• Engage with assigned accounts to facilitate patient access within their respective therapeutic area product(s) by providing proactive, face-to-face education on product-specific programs to providers and staff, thereby aiding in the integration of these programs into office processes and workflows.

• Possess the ability to analyze challenges and propose effective solutions.

• Comprehend the intricacies and support inquiries related to payer policies (such as utilization management, denials, and appeals), drug acquisition and inventory management, as well as patient/practice reimbursement (including co-pay, administration, and drug claims).

• Assess account reimbursement issues and identify opportunities as necessary.

• Recognize trends at local, regional, and national levels and collaborate purposefully both internally and externally to enhance patient pull-through.

• Liaise with the Patient Support Center (hub) on critical matters regarding patient case management, including tracking cases, resolving issues, providing reimbursement support, and educating appropriate office staff.

• Examine patient-specific information in scenarios where the site has formally requested assistance and patient health information is accessible to address any coverage challenges or issues.

• Work in partnership with aligned cross-functional associates within NPC to share insights regarding customer needs and obstacles for their designated therapeutic area product(s) related to access and reimbursement.

• Maintain a thorough understanding of NPC policies and requirements, executing all responsibilities with integrity and in alignment with company guidance as well as prescribed Values and Behaviors. Ensure appropriate handling of Patient Identifiable Information (PII) and compliance with HIPAA and other privacy laws and regulations, along with internal Company compliance guidelines.

⛳️ Requirements

• A minimum of three to five years of experience in the public or private third-party reimbursement field or within the pharmaceutical industry in managed care, clinical support, or sales.

• Experience with specialty pharmacy products obtained through Specialty Pharmacy networks or specialty distributors (buy and bill).

• Familiarity with coding, billing, and office support programs.

• Previous account management experience or experience handling complex accounts (including payer landscape, high patient volume, large systems).

• Knowledge of Managed Care, Government, and Federal payer sectors, as well as Integrated Delivery Networks/Integrated Health Systems.

• Ability to function as a “team player” in collaboration with multiple sales representatives, sales leadership, and internal colleagues to achieve common objectives.

• The candidate must reside within the territory or be within a reasonable daily commuting distance of 60 miles from the territory border. A willingness to travel 60-80% over a broad geography is essential, with the capability to drive and/or fly within the territory. A valid driver’s license is required.

🏝️ Benefits

• A comprehensive benefits package that includes health, life, and disability benefits.

• 401(k) with company contribution and matching.

• A generous time-off package, encompassing vacation, personal days, holidays, and other forms of leave.