Patient Access Manager

This is a fully remote position, open to applicants in New Jersey, +2 more states.

📋 Description

• Act as a key liaison for reimbursement and acquisition logistics pertaining to biologic, orphan-disease, and testosterone products.

• Oversee patient assistance and reimbursement support services.

• Educate patients about Buy/Bill processes, patient assistance options, reimbursement support, and logistics related to Specialty Pharmacy.

• Assess acquisition challenges, account issues, reimbursement trends, affordability concerns, and patient access data.

• Appropriately escalate cases and collaborate with FRMs on remediation strategies.

• Coordinate with patient support representatives, patients, caregivers, provider offices, specialty pharmacies, case managers, and internal stakeholders.

• Resolve Specialty Pharmacy issues and develop solutions with both internal and external customers.

• Identify knowledge gaps among patients and provide educational resources to enhance their understanding of Specialty Pharmacy processes.

• Gather, analyze, and synthesize field intelligence regarding patient access, reimbursement, affordability, healthcare systems, and patient experiences.

• Convert insights from patient journeys and reimbursement trends into strategic recommendations.

• Identify root causes and systemic barriers impacting access, and propose operational enhancements.

• Serve as a recognized expert in patient access and reimbursement.

• Represent the voice of the patient and act as a strategic advisor to Patient Access leadership.

• Support continuous improvement initiatives, pilot programs, launch readiness, and strategic projects.

• Present findings on access trends, reimbursement challenges, and patient experience to internal stakeholders.

• Evaluate and enhance patient support programs, service offerings, access pathways, and engagement strategies.

• Advocate for patients by identifying unmet needs and suggesting process improvements to minimize delays and enhance outcomes.

• Collaborate with leadership on emerging technologies, digital engagement tools, and service models.

⛳️ Requirements

• A BS or equivalent is required; an MBA or advanced degree is preferable.

• 8-10 years of relevant experience in the Biopharma industry is required.

• 5 years of reimbursement experience is mandatory.

• Proven expertise in resolving complex reimbursement, affordability, and access challenges across various payer channels.

• Ability to influence outcomes among cross-functional stakeholders without direct authority.

• Experience in identifying systemic access trends and translating observations into actionable business recommendations.

• A comprehensive understanding of the global payer and distribution landscape, especially related to biologic In-Office Injectables (IOI) in the U.S.

• Familiarity with coverage, coding, payment, and reimbursement requirements and policies.

• Knowledge of Local Coverage Determinations (LCDs) for regional MACs and Keenova products.

• Understanding of Medicare billing/coding and appeals; ASP, WAC, sequestration, and Medicare EOBs.

• Knowledge of legislative, legal, and regulatory frameworks.

• Understanding of buy-and-bill and Specialty Pharmacy channels.

• Awareness of HIPAA requirements and FDA regulations.

• Ability to convey complex clinical, reimbursement, or program-related information in clear, straightforward, actionable terms.

• Proficient in business analytics.

• Strong written and verbal communication skills.

• Capable of developing strategic plans for addressing product access issues.

• Ability to work collaboratively across functions.

• Practical operational reimbursement experience; both in-house and outsourced experience is desirable.

• Up to 30% travel may be necessary.

🏝️ Benefits

• Competitive salary and benefits.

• Comprehensive Total Rewards package.

• Bonus eligibility based on the applicable program.

• Up to 30% travel may be necessary.