Access & Reimbursement Manager, Cardiovascular Central IL & St Louis MO Territory

Job Description Summary

#LI-Remote

Access and Reimbursement Manager (ARM) is a field-based role that proactively provides in person (or virtual as needed) education to defined accounts within their assigned geographies on a wide range of access and reimbursement topics and needs (see below) in support of aligned product(s) strategy.

ARM will serve as the key contact and lead for access and reimbursement support-related matters and is responsible for being the local market access expert on payer policy coverage multi-channel acquisition pathways billing and coding claims processing reimbursement and integration of manufacturer support programs into a range of account workflows. Additionally the ARM will continually need to demonstrate a keen ability to problem solve analyze access and reimbursement issues and opportunities and proactively communicate changes in the healthcare landscape.

ARM will partner closely with other Novartis Pharmaceuticals Corporation (NPC) field associates including Customer Engagement (Sales) and Market Access representing NPC with the highest integrity in accordance with NPC Values and Behaviors. ARM will also be required to coordinate and communicate cross-functionally within NPC (e.g. Patient Support Center Customer Engagement Marketing Market Access Public Affairs State & Government Affairs Trade Specialty Pharmacy Account Management and other applicable third-party affiliates).

This is a remote and field-based role that covers but is not limited to the following locations in the St. Louis MO territory:

Springfield IL
Peoria IL
Champagne IL
Bloomington IL
St Louis MO

The associate must reside within the territory or within a reasonable daily commuting distance (up to 60 miles) from the territory border.

Job Description

Major Accountabilities

• 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.

• Maintain a deep understanding of NPC policies and requirements and perform all responsibilities with integrity and in a manner consistent with company guidance and prescribed Values and Behaviors. Handle Patient Identifiable Information (PII) appropriately (understand and ensure compliance with HIPPA and other privacy laws and regulations and internal Company compliance guidelines).

• Responsible for identifying and reporting adverse events via the established Novartis systems as per applicable processes.

Buy and Bill Specific

• Assess access situation within the assigned geography and develop appropriate Plan of Action (POA). Communicate POA to appropriate personnel.

• Responsible for establishing preferred acquisition pathways. Educate on and support buy-and-bill end-to-end processes workflows and facility pull-through in complex accounts including scenarios of centralized and decentralized acquisition and use of alternative channels such as white bagging clear bagging brown bagging and alternate sites of care for administration.

• Educates relevant stakeholders on logistics related to ordering payment inventory and product returns & replacement.

• Analyze reimbursement issues & opportunities anticipating changes in the healthcare landscape and act as the designated reimbursement expert for offices and field teams.

• Responsible for identifying and reporting adverse events via the established Novartis systems as per applicable processes.

Minimum Requirements

• Bachelors degree preferred.

• 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 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.

• Driving is an essential function of this role meaning it is fundamental to the purpose of this job and cannot be eliminated.

• Because driving is an essential function of the role you must have a fully valid and unrestricted drivers license to be qualified for this role.

• The company provides reasonable accommodations for otherwise qualifiedindividuals with medical restrictions if an accommodation can be provided without eliminating the essential function of driving.

• Superb knowledge of buy-and-bill reimbursement pathway.

• Experience working with established injection networks.

Preferred Qualifications:

• Ability to manage multiple products

• Excellent presentation skills

• Advanced knowledge of medical insurance terminology

• Strong teamwork abilities

• Project management skills

• Ability to work independently

• Ability to manage expenses within allocated budgets

• Good driving record

• Ability to schedule individual work-related travel (air hotel rental car as needed)

• Above average computer skills: PowerPoint Excel Word CRM ()

• Understanding of patient privacy laws including HIPAA and similar state laws

• Strong business acumen

• Ability to travel and possess a valid drivers license to drive to assigned healthcare accounts unless otherwise specified

The salary for this position is expected to range between $138600 and $257400 per year.

The final salary offered is determined based on factors like but not limited to relevant skills and experience and upon joining Novartis will be reviewed periodically. Novartis may change the published

salary range based on company and market factors.

Your compensation will include a performance-based cash incentive and depending on the level of the role eligibility to be considered for annual equity awards.

US-based eligible employees will receive a comprehensive benefits package that includes health life and disability benefits a 401(k) with company contribution and match and a variety of other addition employees are eligible for a generous time off package including vacation personal days

holidays and other leaves.

Company will not sponsor visas for this position.

The individual hired for this role will be required to successfully complete certain initial training including home study in eight (8) or fewer hours per day and forty (40) or fewer hours per week.

Driving is an essential function of this role meaning it is fundamental to the purpose of this job and cannot be eliminated. Because driving is an essential function of the role you must have a fully valid and unrestricted drivers license to be qualified for this role. The company provides reasonable accommodations for otherwise qualified individuals with medical restrictions if an accommodation can be provided without eliminating the essential function of driving.

EEO Statement:

The Novartis Group of Companies are Equal Opportunity Employers. We do not discriminate in recruitment hiring training promotion or other employment practices for reasons of race color religion sex national origin age sexual orientation gender identity or expression marital or veteran status disability or any other legally protected status.

Accessibility and reasonable accommodations

The Novartis Group of Companies are committed to working with and providing reasonable accommodation to individuals with disabilities. If because of a medical condition or disability you need a reasonable accommodation for any part of the application process or to perform the essential functions of a position please send an e-mail to or call 1 and let us know the nature of your request and your contact information. Please include the job requisition number in your message.

Salary Range

$138600.00 - $257400.00

Skills Desired

Accountability Account Management Commercial Excellence Competitive Intelligence Compliance Crm (Customer Relationship Management) Customer Engagement Ethics Healthcare Sector Market Development Problem Solving Skills Process Knowledge Revenue Growth Selling Skills Team Collaboration Value Propositions