Field Reimbursement Manager - Mid Atlantic Region (NJ, PA, DE, MD, DC, VA)

Location
Working from home
Posted
Oct 16, 2020
Ref
5697
Required Education
Doctorate/PHD/MD
Position Type
Full time
Overview

Ready to join a team committed to developing and commercializing gene therapies for patients and families devastated by rare neurological genetic diseases? Since 2013, Novartis Gene Therapies (formerly AveXis) has had one focus: bringing change to those devastated by genetic diseases.

The Novartis Gene Therapies culture embraces this mission. As a compassionate and dedicated team, we are enthusiastic about the science behind our work and finding answers to difficult questions. We are dedicated to communities affected by rare diseases, and these patients and families are the motivation for everything we do.

We have built a team with exceptional depth of experience, unified by a common vision; to develop gene therapies with the potential to positively impact the lives of the patients and families devastated by rare and life-threatening neurological genetic diseases. Though we are proud of what we have achieved to date, we remain relentlessly focused on making that vision a reality.

As the primary liaison between SMA treatment centers and the company's patient enrollment hub, the Field Reimbursement Manager (FRM) will be responsible for ensuring the broadest possible patient access in a reasonable amount of time. The FRM must be a true partner to all internal and external stakeholders such as the Directors of National Accounts (payors), Sales Key Accounts Managers, patient-facing Patient Resource Managers, as well as Care Coordinators at the Hub and physicians, nurses, and office staff at treatment centers.

The FRM will ensure there is a clear pathway to access for product at treatment centers that wish to prescribe. The FRM will diligently follow each prescription through the enrollment, reimbursement, and distribution pathway, ensuring the best possible customer service, communicating plan-specific reimbursement criteria to prescribers and helping them navigate insurance obstacles, providing logistical support as necessary.

***This role will be based and focus on the Mid Atlantic United States Region (NJ, PA, DE, MD, DC, VA)***

Responsibilities
  • Educate hospital pharmacy and reimbursement staff on procurement procedure and distribution networks for our product(s).
  • Establish and maintain relationships with hospital case managers, reimbursement staff, and/or nurses and clinic coordinators and educate on insurance authorization requirements and procedures for our product(s).
  • Diligently support every prescription written to ensure reasonable and payor- appropriate turnaround time once prior authorizations and appeals have been submitted.
  • Educate staff at treatment centers on product reimbursement resources, including billing codes, PA guides, and co-pay support programs.
  • Support buy and bill activity as requested by certain institutions and ensure timely delivery of product in the buy and bill setting.
  • Troubleshoot any obstacles that arise with orders to the Specialty Distributor or the logistics of adjudication through a Specialty Pharmacy.
  • Communicate frequently with treatment center staff with updates on insurance adjudication and distribution timelines. Communicate frequently on the same to Novartis Gene Therapies internal business partners such as sales personnel, Medical Affairs, payor-facing Directors of National Accounts, and patient-facing Patient Resource Managers.
  • Efficiently manage a caseload of 30-50 prescription referrals at a time across a large territory (8-10 states), updating case notes each day to reflect the known status of insurance adjudication decisions and product order and delivery status.
  • Work very closely with the managed care team (Directors of National Accounts) to determine the most up to date and preferred method of processing for product authorization requests upon a prescription being submitted.
  • Maintain an up to date and detailed knowledge of payor-specific coverage policies and procedures for requesting access to product.

Qualifications
  • Bachelors' degree, with a preference for advanced degree or professional credentials (Master's Degree, Registered Nurse, Social Worker, etc.).
  • Minimum of 5 years reimbursement experience in the pharmaceutical industry, including a minimum of three years' experience in the early launch phase for products in the rare disease space.
  • Strong knowledge and understanding of Compliance with respect to HIPAA regulations and OIG guidance in the rare disease space.
  • Experience working with external reimbursement Hubs.
  • Experience managing Specialty Pharmacy relationships in a limited distribution network.
  • Experience with injectable products and "buy and bill" reimbursement pathways.
  • Strong knowledge of the private and public payer landscape.
  • A record of working effectively in a highly collaborative environment.
  • A strong compliance track record supported by previous employers.
  • Excellent organization skills and ability to self-manage.
  • Excellent communication skills as well as the ability to work with diverse personalities, tailoring a customer service approach to the particulars of each situation.
  • 50-75% travel required.


The level of this position will be based on the final candidate's qualifications.

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Novartis Gene Therapies is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity, national origin, genetics, disability, age, sexual orientation or veteran status.