Access and Reimbursement Manager

About the role

We are a fast-growing and dynamic biotechnology company seeking an Access and Reimbursement Manager to join our team. This position will work cross-functionally with Sales, Market Access, and Commercial Operations to ensure timely insights, challenges, and strategies are shared. The role focuses on minimizing reimbursement barriers for patients and providers by staying current on industry best practices, key payer, reimbursement, and policy activities to effectively support healthcare providers and patients.

Key activities include working directly with:

• Inpatient hospital coding and reimbursement staff
• Outpatient office access, coding, and reimbursement staff
• Patient Support Services
• Other stakeholders involved in supporting patient access to Omeros products

Omeros discovers and develops first-in-class protein and small-molecule therapeutics for large-market and orphan indications, focusing on complement-mediated diseases, cancers, and addictive or compulsive disorders. Our lead complement inhibitor, YARTEMLEA® (narsoplimab-wuug), is FDA-approved for the treatment of hematopoietic stem cell transplant-associated thrombotic microangiopathy (TA-TMA). For more information, visit www.omeros.com.

Responsibilities

• Educate inpatient and outpatient billing, coding, office managers, and other care team members on coding, claim submission, payer policies, and reimbursement to optimize access to Omeros therapies.
• Proactively educate accounts on patient support services and resources and partner with the HUB patient program to support efficient patient initiation and continuation of treatment across sites of care.
• Monitor, analyze, and triage situations that may adversely impact patient access to therapy and provide timely feedback to internal/external customers.
• Collaborate cross-functionally with Omeros field teams—including Sales, Market Access, Patient Support, and Medical—to develop and execute account strategies that support timely patient access, provide consistent education on reimbursement and established coverage criteria, and address barriers to treatment.
• Execute account-specific reimbursement initiatives, educational programs, and support services that optimize patient access, strengthen customer confidence in the reimbursement process, and facilitate timely treatment for eligible patients.
• Proactively communicate Omeros-specific reimbursement programs, coding/billing, policies, and resources to HCP personnel related to access.
• Apply strong problem-solving and time management skills to identify and implement solutions that address reimbursement and patient access challenges for healthcare providers, reimbursement professionals, and coding staff.
• Establish relationships with key institution/hospital, physician office, specialty pharmacy, and other personnel associated with coding, billing, support access readiness, treatment initiation, and reimbursement.
• Comply with all federal/state/local laws, regulations, and guidelines, including the PhRMA Code on Interactions with Healthcare Professionals, as well as all Omeros standards and policies relating to job activities.
• Other duties as assigned.

Requirements

• BA/BS Degree with at least 7-10 years of pharmaceutical experience.
• Preferred minimum of 5 years’ experience in reimbursement/payer access.
• Experience with buy and bill is required.
• Product launch experience in the U.S.; experience in oncology/hematology/transplant and/or ultra-rare disease is highly desirable.
• Experience with limited distribution networks, specialty pharmacy, and/or HUB models is preferred.
• Advanced understanding of healthcare, payers, hospital formulary, coverage, reimbursement issues, specialty pharmacy state laws, and compliance laws and regulations.
• Must have demonstrated a high level of proficiency in communication skills, critical thinking/decision-making, influence, problem-solving, and impact, planning, and organization.
• Clinical knowledge in one or more of the following therapeutic areas preferred: Oncology; Hematology; Blood and Marrow Transplant.
• Strong background in products on the medical benefit and how that impacts reimbursement by different payer types (Commercial, Medicare, Medicaid).
• Demonstrated ability to work collaboratively with Sales, Marketing, Market Access, and National Accounts teams to ensure product access.
• Strong communication and educational skills with both internal and external customers that result in product access.
• Strong verbal and written communication skills to provide updates, direction, information, and clarification in a timely manner.
• Strong Microsoft Office skills (Excel and PowerPoint).
• Strong analytical skills.
• Required to travel 50-80%.

Behavioral Competencies

• Demonstrated ability to build and maintain positive relationships with management and peers.
• Operate with integrity, trust, and honesty.
• Ability to address and manage conflicts with internal and external customers.
• Demonstrate positive working relationships through emotional intelligence at various levels of the organization.
• Ability to be flexible and manage change within a dynamic growing organization and an evolving healthcare marketplace as needs dictate.

Pay

The wage scale for this position is $185,000 - $210,000. Salaries will be determined based on knowledge, skills, education, and experience relevant to the role.

Benefits

• Medical, dental, and vision insurance
• Life insurance
• 401(k) plan with a company match
• Three weeks of vacation and 80 hours of sick time accrued annually
• Twelve paid holidays throughout the calendar year
• Eligibility for incentive and stock options