Serve as the primary field-based lead for education, assistance, and issue resolution with office staff with respect to reimbursement for CAR-T.
Invest significant time (up to 75% potentially on-site) with customers assessing their education needs and facilitating collaboration with various stakeholders.
Educate the office staff around how to navigate the access and payer approval process, identifying access barriers that they’ll need to overcome, and highlighting actions that support access to therapy.
Monitor, analyze, and triage situations which may adversely impact patient access to therapy.
Liaise with entire Market Access department, other internal groups including sales, and medical groups to identify and resolve trending issues regarding patient access to therapies.
Serve as subject matter expert for internal stakeholders and external office staff regarding the Medicare treatment guidelines, Medicaid Managed Care, commercial plans, policy changes, formulary status and the impact of healthcare reform on coverage.
Maintain and share relevant information regarding account contacts, prior authorization requirements, trends, competitive intelligence, etc. with the Market Access Department.
Educate peers in the Customer Care Area about various elements of Market Access, including reimbursement, medical coverage policies and medical benefit design.
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
Five years relevant experience of which three years are experience in specialty disease state(s)
Must live within assigned geographic region
Excellent technical knowledge and expertise in payer policy, including all elements of reimbursement (coding, coverage, and payment)
Extensive experience in revenue cycle, buy-and-bill, formulary, prior authorization, coding, and appeals processes
Candidates must live in close proximity to a major airport.
A valid Driver’s License issued in the United States
Advanced degree, or clinical license preferred (Preferred)
Two years of reimbursement or relevant managed care experience (Preferred)
Experience in multiple myeloma or related areas of oncology (Preferred)
Proven ability to thrive in both an independent setting and in a cross functional / team environment. (Preferred)
Strong knowledge as it relates to payer approval process, and solid business acumen. (Preferred)
Strong organizational, problem solving and project management skills. (Preferred)
Understanding of national and state legislative, Medicare, Medicaid, and private payer initiatives affecting reimbursement of pharmaceutical and biotechnology products. (Preferred)
Success exhibiting peer leadership, mentorship and coaching to new hires as well as the rest of the team. (Preferred)
Demonstrated competence with salesforce.com CRM use, native iOS app use, Microsoft Word, and Excel (Preferred)
Superior communication skills (written and verbal) and excellent follow through (Preferred)
Experience in the field, and especially in oncology (Preferred)
Ability to develop and execute education plans (Preferred)
Demonstrated ability to conduct field-based reimbursement and access support, education and consultation (Preferred)

Benefits

Health insurance
401(k) matching
Vacation –120 hours per calendar year
Sick time - 40 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
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

payer policyreimbursementcodingcoveragepaymentrevenue cyclebuy-and-billformularyprior authorizationappeals processes

Soft Skills

organizational skillsproblem solvingproject managementpeer leadershipmentorshipcoachingcommunication skillsindependent workteam collaborationeducation plan development

Certifications

Bachelor's degreeadvanced degreeclinical license