Associate Director, Systems Access & Reimbursement

  • Novartis
  • Newark, NJ, USA
  • Nov 23, 2021
Consultant Finance Health Care Management Marketing Pharmaceutical

Job Description

The Access Reimbursement Manager (ARM) is responsible for ‘access’ to Cardiovascular portfolio within the assigned geography, where ‘access’ means Cardiovascular portfolio is available for use within the assigned systems of care (SOCs), affiliated organizations and other appropriate organizations.

Your Key Responsibilities:
• Coordinate with SET to understand SOC key priorities in atherosclerotic cardiovascular disease (ASCVD), financial goals and population health initiatives to influence overall account and regional business strategies.
• Assess access situation within the assigned geography and develop appropriate Plan of Action (POA). Communicate POA to appropriate personnel.
• Assess and understand SOC and/or other appropriate organizations’ level of centralization of Buy & Bill capabilities (procure, inject & bill) to prioritize accounts and identify the need for alternate sites.
• Work closely with SET to understand P&T ulary processes so that once clinical decision is made to use product, ARM can work with SOC procurement personnel so that SOC facilities and related organizations understand options to acquire product.
• Work with appropriate SOC personnel to validate that access & reimbursement pathways are in place for each major payer within the SOC and assigned geographic region.
• In conjunction with the SET, create the initial POA to support access and reimbursement within the SOC and/or geography.
• Develop SOC/geographic specific POA to address Payer issues and coordinate with SET, Payer Team and FRDs appropriately, including as part of POA, to identify alternate sites for injection where gaps in procurement exist.
• In coordination with the SET educate SOCs and/or other appropriate organizations on NPC policies related to product ordering, payment, inventory, and product returns & replacement.
• Work with key SOC and/or other appropriate organization staff members (i.e., procurement, billing, reimbursement staff) in order to appropriately support patient access to product by providing overview of services available to support patient access (PSS).

What you’ll bring to the role:
• Bachelor’s Degree required. Advanced degree preferred.
• Significant experience in one or more of the following areas:
• 5+ years of experience as: Access and/or Reimbursement Manager; Sales, Regional or Corporate Account IDN Management, Hospital Account Management.
• In pharmaceutical/biotech industry reimbursement and practice management support role and managed markets environment.
• Substantial procurement experience (SDs, GPOs, SPP).
• Strong knowledge of buy-and-bill billing and reimbursement pathway.
• Possess a strong understanding of Commercial payers, Medicare plans and state Medicaid in assigned geographic region.
• Experience in patient assistance support, reimbursement support and/or other access programs.
• Travel by air or car within and outside the assigned geography required, as needed, to fulfill job responsibilities.
• Must live within 60 miles of the territory.
• This position requires significant use of a company provided vehicle.
• This is a field-based customer engaging position.

Preferred Qualifications:
• Experience leading and delivering presentations to C-level account executives.
• Strong ability to work cross functionally with such functions as Field Sales, Marketing, Market Access (Payer teams), Public Affairs, State & Government Affairs, Trade, Specialty Pharmacy Account Management and applicable third-party affiliates.
• Ability to coordinate/manage large project.
• Expertise in SOC dynamics and common access, reimbursement and product program support-related needs.
• Strong capabilities in the areas of technical and business expertise, achieving results, customer focus, teamwork and collaboration, business acumen, and communication.