Qualifications
- BA/BS required, preferably in one of the following areas: Business Administration, Communications, Healthcare Management, Marketing, Nursing, and Pharmacy.
- The ideal candidate will have 5-7 years of reimbursement, including buy & bill & Specialty Pharmacy experience within the biopharmaceutical injectable/infusion sector
- Demonstrated knowledge of injection/infusion processes and/or diagnostic processes
- Experience in the establishment of new sites of care and the management of patients and payer coverage across complicated care journeys.
- Comprehensive understanding of all aspects of complex reimbursement models (coding, coverage, and payment), including complete understanding of Medicare A, B, C and D benefit designs, Medi-gap, physician fee schedule and ability to locate applicable coverage policies
- Demonstrated advanced level billing competencies including CPT, ICD-10, HCPCS coding and EOB interpretation
- Ability to negotiate and execute sophisticated/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.
- A successful track record across field reimbursement, clinical education or pharmaceutical account management of products that required significant payer and reimbursement support, with specific emphasis on a public payer.
- Significant managed care and/or infusion experience (e.g. oncology, rare disease) within pharmaceutical industry
- Comprehensive understanding of all aspects of complex reimbursement models (coding, coverage, and payment), including complete understanding of Medicare A, B, C and D benefit designs, Medi-gap, physician fee schedule and ability to locate applicable coverage policies
- HUB and/or Patient service model experience, and financial assistance programs
- Exemplary and collaborative work ethic, cross-functional stakeholder management skills, project management skills, and an ability to manage multiple and often-evolving strategic priorities.
- Excellent written and verbal communication and presentation skills, tailored to various levels of internal and external audiences up to and including executive audiences.
Additional Information
In this field-based, regional scope position, the Alzheimer’s Disease Reimbursement Manager (ADRM) is the subject matter expert for the billing, coding, reimbursement and patient access issues related to administration of therapy at site of care accounts/facilities (i.e. infusion centers, memory centers, integrated systems/hospitals, physician offices). The ADRM will educate and support the site of care account and infusion decision makers, healthcare providers and staff members on procurement, billing and delivery process as well as reimbursement, payer policy requirements, and clinical information when appropriate. The ADRM is responsible for pulling through the Site of Care Administration Strategy enabling patient access to therapy while collaborating closely to support the Alzheimer’s Account Liaisons and other customer facing teams as necessary and appropriate.