Regional Market Access Manager

  • Dendreon
  • Seattle, WA, USA
  • Apr 04, 2022
Health Care Management Marketing Pharmaceutical Sales

Job Description

The Regional Market Access Manager (RMAM) is responsible for unimpeded patient access to Provenge within the assigned geographical area. The RMAM will develop and implement strategies that will maximize business opportunities for growth. This position works with regional Payors, state Medicaid plans, medical practice decision makers, CFO’s, CEO’s, pharmacy and medical directors, purchasing departments, key stake holders within state Medicaid departments, insurance companies, community based urology and oncology practices along with academic and community based hospitals, medical centers, clinics, etc. to effectively reduce medical policy restrictions and practice reimbursement barriers.  This position will partner with the Dendreon Market Access Director on all payor issues.

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.
  • Meets with Regional Payors and State Medicaid programs under the supervision and partnership of the National Director of Market Access and Reimbursement or the Director of Market Access. 
  • 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, Payors 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.

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 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 Regional Market Access Manager (RMAM) will cover multiple regions and thus significant overnight travel is required, estimated at 60%.