The Manager for Oncology Access and Reimbursement Services will implement the development, implementation and on-going management of the Oncology Access and Reimbursement Services team. The Access and Reimbursement Services team will be responsible for serving as a dedicated point of contact, fully integrated with the AbbVie Oncology Access & Reimbursement Service model, for healthcare providers and patients for their access and reimbursement support needs. The Team will help patients and healthcare providers navigate through patient support and reimbursement issues. The Manager will ensure compliance with federal, state and AbbVie requirements. The Manager must be able to collaborate cross -functionally and promote a culture of patient centricity and a high standard of support excellence within the team and Pharmacy Solutions and meeting agreed upon goals and objectives. Key Responsibilities Include:
- The Manager for Oncology Access and Reimbursement Services will implement the development, implementation and on-going management of the Oncology Access and Reimbursement Services team delivering both centralized and field based capabilities.
- The Oncology Access and Reimbursement Service model is responsible for serving as a reimbursement navigator for patients, healthcare providers and pharmacies that opt into Access and Reimbursement Services for both oral and IV AbbVie Oncology products.
- Access and Reimbursement Case Coordinator team will independently manage a case load within his/her assigned area and provide seamless coverage for other Access and Reimbursement Case Coordinators case load when necessary.
- Successfully manage critical conversations with patients, healthcare providers and pharmacies.
- Perform comprehensive assessment of each case to determine appropriate avenue to maximize patient access to AbbVie Oncology products.
- Serve as the Pharmacy Solutions point of contact overseeing the contracted Oncology Access and Reimbursement Field Reimbursement program in close collaboration with their cross functional counterparts, including representing Pharmacy Solutions in vendor contracting negotiations, collaborating on KPI development and monitoring, development and execution of seamless operating model between the ARCC and FRM roles and compliance monitoring.
- Partner with external Field Reimbursement team to identify additional resources and share current payer and reimbursement trends. Respond to reimbursement questions and identify alternative resources available.
- Provide guidance through Open Enrollment, including Medicare Part D. Determine eligibility for AbbVie free goods program. Provide support to customers in the implementation of AbbVie REMs programs (if applicable).
- Develop and maintain a localized understanding of market access challenges. Utilize expertise to educate patients, healthcare providers and internal cross-functional partners.
- Develop and execute AbbVie Access and Reimbursement Services business plan for accounts in assigned area. Establish goals and develop support plan.
- Bachelor's degree in health sciences or business preferred. MBA qualification is desirable. Comparable or relevant experience will be considered.
- 3-5 years' experience leading reimbursement support teams in a hospital facility or large scale medical office specializing in oncology is highly desirable.
- Demonstrate thorough knowledge of reimbursement and access best practices across multiple Patient Access Support options (hospital charity programs, manufacturer patient assistance programs, co-pay card programs, etc.)
- Strong problem solving skills related to complex patient access challenges.
- Experience working with providers to resolve or prevent account issues related to proper coding, billing, denials, and claims appeals related to product coverage and reimbursement.
- Experience educating and mentoring peers and direct reports.
- Experience educating office and hospital staff in reimbursement processes including payer requirements for Prior Authorization, Pre-Determination, Appeals, and Claims submission guidelines.
- Knowledge of Commercial and Medicare reimbursement guidelines and insurance plan reimbursement methodology.