Rare Disease Reimbursement Manager, Gulf Coast Territory

Job Description

In this field-based, regional/national scope position, the SMA Rare Disease Reimbursement Manager (RDRM) is the subject matter expert for the billing, coding, reimbursement and patient access issues for administration related to administration site of care accounts/facilities (i.e. hospitals, SMA centers, physician office, etc.) in the one of the geographic regions of United States. The RDRM’s will educate and support site of care account and ancillary healthcare providers and staff members on procurement, billing and delivery process as well as reimbursement, payer policy requirements, and clinical information when appropriate. The RDRM is responsible for pulling through the Site of Care Administration Strategy enabling patient access to therapy while collaborating closely to support the Account Executives and Family Access managers as necessary.

The primary goals of the RDRMs are to:

Engage and work strategically with C-Suite institutional leadership, HCPs, and support personnel of all potential sites of care to deliver information that facilitates patient access and reimbursement for Biogen’s rare disease therapy, acting as the subject matter expert on all aspects of reimbursement, procurement options and both public and private payer policy coverage determination criteria.

Work closely with the administration or SMA treatment, site of care accounts to support pull-though on patient dispositions and monitor dosing requirements and administration.

Educate prescribers and site of care accounts on specialty pharmacies requirements and options for procurement to identify potential opportunities to improve administration.

Establish active communication and liaison with Account Executives and Family Access Managers on all related procurement, reimbursement, and account management issues and ensure that issues are resolved in a timely manner. This will include strategic capacity analysis navigation and exploration of new sites of care when need is identified.

Serve as the regional reimbursement resource for targeted customer accounts providing both technical and practical advice to avert or resolve reimbursement issues and support patient access.

Understand local payer payment trends, policies and relationships to assist product adoption and sales growth. Organize and lead reimbursement presentations to key decision makers in targeted accounts.

Work with internal cross-functional partners (MA&R Payer Marketing) to assist in implementing pull-through and push-through programs designed to maximize payer coverage.

Conduct key account reimbursement presentations to provide reimbursement information as well as local payer status updates.

Will proactively provide account level business reviews to improve patient access & retention to therapy.

Assist with activities to support patient pull through.

Key responsibilities:

- Ability to execute C-suite level site of care discussions related to various health care topics related to access and reimbursement and able to set and pull through account level access strategies.

-Ability to lead cross- functionally, communicate and collaborate with customers, sales organization, ARM team colleagues, account management, and Biogen support personnel.

- Ability to complete work with minimal direct supervision.

- Ability to negotiate and resolve problems using diplomacy, poise and tact.

- Ability to manage multiple and different strategic reimbursement projects, including the ability to reprioritize work quickly to meet objectives.

- Ability to monitor and report on the regulatory environment.

- Ability to maintain extensive overnight travel (up to 70%). Ability to invest time, as required, to expedite or complete assignments which may necessitate working evening and/or weekend hours as necessary to meet business demands.

Qualifications

- Minimum of 5-7 years of reimbursement/including orphan drug, buy & bill & Specialty Pharmacy experience within the injectable/infusion sector in the biopharmaceutical channels of business.

- Demonstrated knowledge and understanding of injection/infusion processes to include the establishment of new sites of care and the management of patients and payer coverage.

- A successful track record in field reimbursement, clinical education or in pharmaceutical sales/management of products that required significant payer and reimbursement support.

- Pharmaceutical sales background with significant managed care and/or injectable experience, with ultra-orphan drug experience preferred.

- Comprehensive understanding of all aspects of reimbursement (coding, coverage, and payment).

- HUB and/or Patient service model experience

- Demonstrates outstanding work ethic, relationship management skills, project management skills, and an ability to manage many tasks at a time.

- Excellent written and verbal communication skills.

Education:

Bachelor’s Degree BA/BS required preferably in one of the following areas: Business Administration, Communications, Healthcare Management, Marketing, Nursing, and Pharmacy

Additional Information

Preferred cities for candidates to live for thisrole are:Gulf Coast Territory (Major cities: Houston, Dallas, Austinand Miami)