Regional Clinical Manager
PM Pediatric Care
Access and Reimbursement Manager, Immunology
Novartis
full-time
Posted on:
Location: 🇺🇸 United States
Visit company websiteSalary
💰 $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
