Associate Director Patient Access Reimbursement

A career with EMD Performance Materials is an ongoing journey of discovery: our 57000 people are shaping how the world lives works and plays through next generation advancements in healthcare life science and performance materials. For more than 350 years and across the world we have passionately pursued our curiosity to find novel and vibrant ways of enhancing the lives of others. EMD Performance Materials is a business of Merck KGaA Darmstadt Germany.

This role does not offer sponsorship for work authorization. External applicants must be eligible to work in the US.

The Associate Director Patient Access and Reimbursement plays an integral role within EMD Seronos Patient Support Center MS LifeLines (MSLL). As part of the overall patient support services function the Associate Director leads the implementation of reimbursement initiatives and appeals strategies to help ensure appropriate reimbursement coverage and patient access in compliance with all relevant laws regulations rules and company policies and procedures. You will oversee all activities of the Patient Access Reimbursement and Support teams within MSLL which consists of Case Managers and will be responsible for direct management of Managers of Patient Access and Support Supervisor of Patient Support and Associate Manager of Patient Access Quality. The department also works with contract staff at times of heavy volume and the Associate Director is responsible for the sourcing and managing that process. You will oversee all frontend processes for MSLL which includes traditional patient support reimbursement and patient access. The teams reporting to this role are responsible for providing patient education advocacy and reimbursement assistance. This includes insurance eligibility and benefit verification securing insurance authorizations advocating for maximum reimbursement coverage and appealing insurance denials.

Leadership of the teams that are responsible for offering information and assistance on available alternate funding programs for those eligible participants involved in various teams manage and implement specific activities to help support patients using various assistance programs which include both EMD Seronos Copay Assistance program for those patients in need of financial assistance and Patient Assistance Program or Free Goods for those patients without insurance. These activities and strategies are developed by the MSLL Hub team in collaboration with the Brand teams. This individual will be responsible for managing the day to day implementation

You will play a key role in managing and developing the team members to excel in their function and support their career development. This individual will also run the day to day operations of the Access and Reimbursement team and hold the team accountable towards their individual goals and overall business goals as laid out in the KPIs and Metrics for the organization.

Your Role:

• Drive a performancedriven culture which includes mentoring coaching developing measurable objectives and overall performance management of staff ensuring completion of performance management process the teams and providing specific feedback to management regarding team and individual performance
• Provide regular oversight and direction to the teams to ensure that all laws regulations and EMD Serono / MSLL policies and procedures are followed
• In a fully compliant and legal manner ensure that the teams assist patients in need of assistance from unaffiliated thirdparty nonprofit charitable foundations by providing appropriate referrals
• Implement and maintain analytical and reporting capabilities to provide timely information and data to senior management and to support call center managed care and sales related activities
• Ensure collaboration between the teams with both internal and external customers and manage special department projects from design to implementation
• Ensure MSLL collaboration with Field Patient Services team
• Develop and deliver presentations to educate both internal and external customers
• Ensure privacy of patient information that is provided due to HIPAA regulations
• Ensure accurate and timely database input including orders and Patient Assistance Program (PAP) coordination work and manage overall performance of the teams including case load closure rates PAP activity and quality of work as it relates to process approval rates and customer satisfaction
• Manage the delivery of department reports necessary for the monitoring and tracking of all departmental activities including referrals to specialty pharmacy customers
• Lead the daytoday management of vendors utilized for outsourced reimbursement cases
• Ensure the teams are trained and prepared to handle all reimbursement related activities and or experienced and knowledgeable on local and regional reimbursement scenarios
• Ensure the teams appropriately assist with efforts of patients in search of product assistance or those who may seek alternate funding
• Ensure the appropriate level of management and oversight to any escalated customer cases
• Ensure the appropriate expectations for Quality Monitoring of Specialist phone calls are performed and meet the departmental standards to ensure accurate exceptional service and timely database entry
• Provide appropriate management of the teams so they can gather and deliver approved medical information or triage to RN Support team for advanced medical questions complaints
• Provide appropriate management of the teams so they can collaborate with patient physicians/nurses or other healthcare professionals to provide consistent product information
• Update the Brand teams with feedback from customers to improve services or provide recognition of staff members
• Meet Finance expectations associated with the payment of invoices through SAP and the appropriate functioning of Vendor relationships to contract requirements
• Oversee and manage the financial responsibility within EMD Serono relative to the necessary approvals and management of the successful business operations of MSLL
• Interact present to and with senior level management.
• Manage relationships with and coordinate operations with the Access and Influence Managers team within MACS
• Ensure critical patient case pull through initiatives are on track to maintain appropriate levels of patient access

Who you are:

Minimum Qualifications:

• Bachelors degree required preferably in a related discipline
• Must be flexible in working hours shift work and weekend shifts may be required
• Limited travel required
• 5 years work experience in healthcare managed care insurance or pharmaceutical/biotechnology industry is a prerequisite
• 5 years direct supervisory or management experience is required
• Functional experience in reimbursement and health care consulting provider relations operations nursing medical marketing or customer service programs required
• Knowledge of reimbursement healthcare regulatory or health insurance policies related to pharmaceutical biotech or medical device industry
• Understanding of key drivers within the business to drive performance
• Knowledge of Copay foundations
• Excellent computer literacy (databases presentation software financial software Salesforce)
• Effective leadership skills (Inspirational Motivational)
• Strong People Management Skills and Business Knowledge
• Excellent team building skills with a creative approach.
• Strong Interpersonal and Relationship Management Skills (able to build relationships and network)
• Strong Business analytical skills: to understand and adjust to trends and market dynamics
• Ability to quickly grasp and implement business objectives and manage resource allocation
• Ability to continuously demonstrate company core values including transparency courage and respect
• Adaptable and flexible with ability to lead and manage change
• Results oriented with a proven track record of success
• Excellent Communication and interpersonal skills as demonstrated by:
  • Ability to access and influence various functional areas and motivate groups to actions encouraging teamwork that respects and encourages ideas and collaboration
  • Ability to translate complex information into sufficient and impactful messages
  • Ability to present to all levels of the organizations and to individuals and groups as well as respond succinctly and clearly to any questions

Preferred Qualifications:

• Experience working with Specialty Pharmacies a plus

• Knowledge and/or experience within the therapeutic area helpful

What we offer: With us there are always opportunities to break new ground. We empower you to fulfil your ambitions and our diverse businesses offer various career moves to seek new horizons. We trust you with responsibility early on and support you to draw your own career map that is responsive to your aspirations and priorities in life. Join us and bring your curiosity to life!

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The Company is an Equal Employment Opportunity employer. No employee or applicant for employment will be discriminated against on the basis of race color religion age sex sexual orientation national origin ancestry disability military or veteran status genetic information gender identity transgender status marital status or any other classification protected by applicable federal state or local law. This policy of Equal Employment Opportunity applies to all policies and programs relating to recruitment and hiring promotion compensation benefits discipline termination and all other terms and conditions of employment. Any applicant or employee who believes they have been discriminated against by the Company or anyone acting on behalf of the Company must report any concerns to their Human Resources Business Partner Legal or Compliance immediately. The Company will not retaliate against any individual because they made a good faith report of discrimination.