Serve as the primary field-based lead for education, assistance, and issue resolution with healthcare providers (HCPs) regarding patient access to J&J Immunology therapies.
Invest time (up to 50%) on-site with HCPs, assessing their education needs and facilitating collaboration with various stakeholders.
Educate HCPs on product coverage, prior authorizations and appeals, reimbursement processes, claims submissions, procedures, and coding requirements of payer organizations (local payers, government payers, etc.) for core and launch products.
Collaborate with field support team members such as sales representatives and key account managers and serve as reimbursement expert for the local team.
Act with a sense of urgency to address critical access and affordability issues for patients.
Partner with managed care colleagues to understand current policies and potential future changes.
Conduct field-based reimbursement and access support, education and creative problem-solving aligned to FRM Rules of Engagement.
Build strong, trust-based relationships with customers in all assigned Immunology accounts.
Manage territory logistics, routing, and account business planning.
Maintain and grow knowledge of national, regional, local, and account market dynamics including coverage and coding requirements.
Grow the knowledge of hub and specialty distribution channels to improve practice and patient support needs.
Collaborate with internal J&J departments such as marketing, sales, medical science, SCG, IBG, HCC, and PECS.
Execute business in accordance with the highest ethical, legal, and compliance standards, including timely and successful completion of all required training.

Requirements

Bachelor’s degree (preferably in healthcare or business/public administration).
An advanced business degree (MBA), or public health (MPH) is preferred.
Minimum of 5 years of relevant professional experience.
Account Management and/or Reimbursement experience working in the hospital and/or provider office setting, building strong customer relationships.
Demonstrated expertise with both pharmacy and medical/buy & bill benefits (as applicable), coding, and billing.
Reimbursement or relevant managed care experience (revenue cycle, buy-and-bill, prior authorization, coding, and appeals processes).
Ability to establish relationships, collaborate, and influence across a matrix organization.
Problem-solving ability to navigate challenging access scenarios and identifies solutions in a timely and efficient manner.
Experience in working with patient support HUB services.
Valid US driver’s license and a driving record in compliance with company standards.
Ability to consistently maintain up to 50% travel.
Permanent residence in the listed territory.
Preferred Immunology disease state experience.
Advanced degree and/or relevant certifications in prior authorization and/or billing and coding.
Strong market access acumen as it relates to payer approval processes and business acumen.
Understanding of Medicare, Medicaid, and private payer initiatives affecting reimbursement of pharmaceutical and biotechnology products.
Excellent technical knowledge and expertise in payer policy, including all elements of reimbursement (coding, coverage, and payment) is preferred.
Demonstrated competence with salesforce.com CRM use, Microsoft Word, and Excel.

Benefits

Subject to the terms of their respective plans, employees are eligible to participate in the Company’s consolidated retirement plan (pension) and savings plan (401(k)).
This position is eligible to participate in the Company’s long-term incentive program.
Subject to the terms of their respective policies and date of hire, employees are eligible for the following time off benefits: Vacation –120 hours per calendar year Sick time - 40 hours per calendar year; for employees who reside in the State of Colorado –48 hours per calendar year; for employees who reside in the State of Washington –56 hours per calendar year Holiday pay, including Floating Holidays –13 days per calendar year Work, Personal and Family Time - up to 40 hours per calendar year Parental Leave – 480 hours within one year of the birth/adoption/foster care of a child Bereavement Leave – 240 hours for an immediate family member: 40 hours for an extended family member per calendar year Caregiver Leave – 80 hours in a 52-week rolling period 10 days Volunteer Leave – 32 hours per calendar year Military Spouse Time-Off – 80 hours per calendar year

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

reimbursementcodingbillingprior authorizationappeals processesaccount managementpharmacy benefitsmedical benefitsbuy-and-billmarket access

Soft Skills

relationship buildingcollaborationinfluenceproblem-solvingcommunicationurgencytrust-buildingcreative problem-solvingcustomer serviceorganizational skills

Certifications

advanced degreeMBAMPHcertifications in prior authorizationcertifications in billingcertifications in coding