RN Care Manager – Pediatrics
Centene Corporation
Access and Reimbursement Manager – Multiple Sclerosis
Novartis
full-time
Posted on:
Location Type: Remote
Location: Remote • Texas • 🇺🇸 United States
Visit company websiteSalary
💰 $138,600 - $257,400 per year
Job Level
Mid-LevelSenior
About the role
- Interact within assigned accounts to support patient access within their therapeutic area product(s) providing proactive face-to-face education on product-specific programs to providers and staff in order to support integration of those programs into office processes and workflows.
- Address customer questions for issues related to NPC policies on therapeutic area product ordering, payment, inventorying, and product returns & replacement in offices.
- Work with key members of therapeutic area offices (e.g., providers, administrators, billing and coding staff, claims departments, revenue cycle managers) in order to appropriately support patient access to products.
- Ability to analyze problems and offer solutions. Understand specifics and support questions associated with payer policies (e.g., utilization management, denial, and appeals), drug acquisition and inventory management, and patient / practice reimbursement (e.g., Co-pay, administration, drug claims). Analyze account reimbursement issues & opportunities (as needed). Identifies trends at a local, regional and national level and partner with purpose internally and externally to support patient pull-through.
- Supports pull through on local coverage decisions to enable meaningful patient access within the system. Proactively communicate policy changes or issues that could potentially affect other departments.
- Accountable for standing up NVS-sponsored patient support programs to enable patients starting and staying on therapy (i.e., Co-pay).
- Maintain expertise in regional and local access landscape, anticipating changes in the healthcare landscape, and act as their aligned therapeutic area product(s) reimbursement expert (as needed).
- Interface with Patient Support Center (hub) on important matters related to patient case management, including tracking cases, issue resolution, reimbursement support, and appropriate office staff education. Review patient-specific information in cases where the site has specifically requested assistance and patient health information is available in resolving any issues or coverage challenges. Collaborate with aligned cross-functional associates within NPC (see above) to share insights on customer needs and barriers for their aligned therapeutic area product(s) related to access and reimbursement.
Requirements
- Minimum three to five years' experience in public or private third-party Reimbursement arena or pharmaceutical industry in managed care, clinical support, or sales
- Experience with specialty pharmacy products acquired through Specialty Pharmacy networks or specialty distributors (buy and bill)
- Experience with coding, billing and in office support programs
- Prior account management experience or prior experience with complex accounts (Payer landscape, high patient volume, large systems)
- Specialty pharmacy experience required (ability to teach an office the entire process from script to injection)
- Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare Parts B and D (Medical and Pharmacy Benefit design and coverage policy) a plus
- Knowledge of Managed Care, Government, and Federal payer sectors, as well as Integrated Delivery Network/Integrated Health Systems a plus
- Ability to operate as a "team player" in collaborating with multiple sales representatives, sales leadership, and internal colleagues to reach common goals
- Ability to travel and cover large multistate geography territories, at least 50% travel required, based on geography and territory / targeting make up.
- Must live within assigned territory.
Benefits
- Health insurance
- 401(k) eligibility
- Various paid time off benefits, such as vacation, sick time, and parental leave
- Sign-on bonus
- Restricted stock units
- Discretionary awards
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
reimbursementcodingbillingpatient case managementdrug acquisitioninventory managementutilization managementdenial and appealsspecialty pharmacyaccount management
Soft skills
problem analysissolution offeringcommunicationcollaborationteam playerproactive educationcustomer supporttrend identificationcross-functional collaborationadaptability
