Novartis

Access and Reimbursement Manager, Immunology

Novartis

full-time

Posted on:

Origin:  • 🇺🇸 United States

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Salary

💰 $138,600 - $257,400 per year

Job Level

Mid-LevelSenior

Tech Stack

SFDC

About the role

  • Interact with assigned accounts to support patient access and provide education on product-specific programs
  • Address questions about NPC policies on product ordering, payment, inventorying, and returns
  • Work with providers, administrators, billing staff, claims departments to support patient access
  • Analyze problems and provide solutions; understand payer policies, drug acquisition, inventory management, and patient/practice reimbursement
  • Analyze account reimbursement issues and opportunities; identify local/regional/national trends
  • Support pull-through on local coverage decisions and patient access
  • Communicate policy changes affecting other departments
  • Stand up NPC-sponsored patient support programs (e.g., Co-pay)
  • Maintain expertise in regional/local access landscape and act as reimbursement expert
  • Interface with Patient Support Center for cases and education
  • Review patient-specific information; assist with coverage challenges
  • Collaborate with cross-functional NPC teams to share insights
  • Maintain adherence to NPC policies and integrity
  • Handle Patient Identifiable Information per HIPAA
  • Identify and report adverse events per Novartis systems
  • Buy and Bill: educate on acquisition pathways; POA; document
  • Establish preferred acquisition pathways; educate and support buy-and-bill end-to-end processes
  • Educate stakeholders on logistics of ordering, payment, inventory, returns

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)
  • Establishing relationships within a practice by working closely with them to help remove Reimbursement barriers to specialty products for their patients
  • Knowledge of 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 travel and cover large multistate geography territories, at least 50% travel required
  • Must live within assigned territory
  • Driving is an essential function of this role, meaning it is fundamental to the purpose of this job and cannot be eliminated
  • Superb knowledge of buy-and-bill reimbursement pathway
  • Experience working with established injection networks