Job Description

The Field Access Navigator (FAN) plays an integral role in the success of minimizing reimbursement barriers and optimizing access to Aurinia products for patients and health care providers (HCP). Within the context of an integrated, cross-functional operational plan, the FAN is responsible for addressing access restrictions by working strategically with HCP’s and their office staff to resolve issues related to prior authorizations, denial and appeal processes and solving the most complex patient access challenges. The primary role of the FAN is to work closely with prescribing HCP’s and their office staff, as well as Specialty Pharmacy reimbursement staff on any access issues requiring escalation from the Specialty Pharmacy. The FAN will also help facilitate resolution of HCP challenges as they arise by including appropriate Aurinia cross- functional team members. The FAN will develop a customer-oriented reimbursement strategy and proactively communicate payer criteria/terms and practices, as they relate to reimbursement for the assigned Aurinia products.

PRIMARY RESPONSIBILITIES: 

• Provide face-to-face, personalized access issue resolution as the Patient Services payer subject matter expert, in efforts to support the healthcare provider segment.
• Work with cross-functional teams to build strategic patient access and reimbursement plans for prior authorization of Aurinia’s products.
• The FAN will coordinate case escalation to the Corporate Account Directors appropriate.
• Coordinate with Specialty Pharmacy and HUB staff to resolve any denial or appeals.
• Obtain and maintain knowledge to be a subject matter expert on the payer landscape relevant to Aurinia products in order to educate HCPs and their office staff on national, regional and local coverage policies and processes.
• Be the conduit between cross-functional field facing teams and other Aurinia functions for all public and private payer policies and practices that impact patient access to Aurinia products.
• Proactively communicate and explain Aurinia-specific reimbursement programs, policies, procedures and resources so that HCP office staff are well educated on how to use Access Programs for Aurinia products
• The FAN will anticipate, navigate, and address individual account and patient access issues that occur by partnering with all appropriate stakeholders.
• Assist in providing appropriate field insights throughout the development of Patient Services marketing support materials as needed
• Understand Anti-bribery & Corruption (ABAC) requirements to ensure laws and regulations of the pharmaceutical industry and Aurinia Policies are being following
• Stay abreast of healthcare industry trends and identify patterns or connections between situations and communicate possible future challenges.
• The FAN may be assigned to different products in the future as Aurinia launches additional assets.

Qualifications

The preferred candidate comes with strategic and operational reimbursement experience and familiarity with office practice policies and procedures. Must have a strong cross-functional communication mindset, is solutions-oriented and has strong verbal and written communication skills. Produces results, able to adapt to the changing priorities intrinsic to a growing company and needs minimal supervision.

Preferred Experience

• Bachelor’s Degree required, RN or clinical background preferred
• Four or more years of market access, insurance reimbursement, large Healthcare Practice reimbursement or billing experience including Medicare/Medicaid programs with a focus on specialty drug products
• A minimum of two or more years of demonstrated excellence and working knowledge of reimbursement support and resolution directly with HCP office staff
• Demonstrated ability of applying reimbursement knowledge to address/resolve patient access barriers
• Previous experience with both private & public payers is strongly preferred
• Previous experience in other functions within the pharmaceutical/biotech industry is a plus, e.g. product marketing, managed care, field sales, case management or large Healthcare Practice experience
• Proven track record of consistently meeting or exceeding goals and objectives
• Knowledge of CMS policies and processes with expertise in Part D (Pharmacy Benefit design and coverage policy)
• Knowledge of Commercial Insurers, Managed Care, Government, and Federal payer sectors
• Knowledge of Integrated Delivery Network/Integrated Health Systems
• Previous experience in creating, implementing, and completing attainable business plans
• Understanding of national laws regarding reimbursement and regulations that impact the FAN role
• Frequent travel is required to manage the assigned territory, sometimes without much notice

Additional Information

All candidate information will be kept confidential according to EEO guidelines.