Access & Reimbursement Manager (Jacksonville)

Responsibilities

• Proactive Office Support Throughout FILSPARI Onboarding Process
• Cultivate the highest level of expertise in the FILSPARI onboarding process, from Patient Start Form (PSF) submission through REMS enrollment to reimbursement.
• Walk offices through what to expect from the FILSPARI onboarding process, either when a new PSF comes in or when an opportunity for re-education is identified.
• Educate physicians and physician practices on the full FILSPARI onboarding process, including how to complete the PSF, how to enroll patients and physicians in REMS, requirements for prior authorization approvals, appeal approvals, and specific medical policy steps to obtain reimbursement.
• Closely monitor cases as they progress through the onboarding process.
• Escalated Support for Specific Cases
• Proactively identify and solve complex patient access issues by working across the Hub, HCP offices and communicating with field team.
• Educate physicians (in-person or virtual) on escalated reimbursement issues.
• Aid physicians and office staff when PSFs or REMS enrollment forms are submitted with information missing; coordinate with Hub and REMS Administrator partners to be able to clearly explain to the office what information is missing.
• Aid physicians and office staff in resolving access issues (prior authorization, appeals, denials, letters of medical necessity, REMS), and help ensure appropriate education to avoid future reimbursement hurdles.
• Effectively partner with reimbursement stakeholders (specialty pharmacy, sales team, HCP office, REMS administrator, etc.) to communicate challenges, identify solutions, and ensure the patient is progressing through the reimbursement process.
• Understand specifics and support questions associated with PSF submission, REMS enrollment, payer policies (e.g., PAs process and denial, and appeals), patient reimbursement (e.g., Co-pay, PAP), reimbursement issues & opportunities (as needed).
• Sales Force Communication / Partnership
• Proactively seek out timely and regular updates on case statuses, leveraging network of reimbursement stakeholders.
• Periodically ride with and educate sales force on complexities surrounding the pharmaceutical reimbursement process.
• Maintain a level of expertise on specific payors and the requirements for claim approvals.
• Log calls and notes within standardized platform daily, to provide clear and concise updates that drive toward action and emphasize next steps and owners (based on standardized template).
• Lead weekly case status update meetings with sales force and sales leadership in a way that demonstrates confidence and preparedness and emphasizes specific next steps / owners.
• Cook up with Hub, specialty pharmacies, and REMS administrator stakeholders to regularly share information and work together to move cases forward efficiently and smoothly.
• Balance daily tasks and schedule to accommodate ad-hoc communication from the sales force and sales leadership without delays to other ARM priorities.
• Operate in compliance with HIPAA within program guidelines.

Qualifications

• Bachelor’s degree in related field required. Equivalent combination of education and applicable job experience may be considered.
• 5+ years in pharmaceutical / health industry working with Hubs, payers, HCPs or related area.
• 3+ years reimbursement / access / case management experience.
• Specialty pharmaceutical, nephrology, rare disease, REMs experience preferred.