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· Engage and work strategically with C-Suite and/or business decision-makers, relevant HCPs, and support personnel of potential sites of care to deliver information that facilitates patient access and reimbursement for Biogen’s Alzheimer’s therapy. Act as the subject matter expert on all aspects of reimbursement, procurement options and both public and private payer policy coverage determination criteria.
· Work closely with the account administration stakeholders and therapy site of care accounts to support pull-through, including discussion around dosing requirements and administration.
· Educate prescribers and site of care accounts on procurement requirements and options for procurement to identify potential opportunities to improve administration.
· Establish active communication and liaise with Alzheimer’s Account Liaison and Patient Service teams on all related procurement, reimbursement, and account access and reimbursement management issues and ensure that issues are resolved in a timely manner. This will include understanding of the strategic capacity analysis navigation and supporting exploration and pull through of new sites of care when the need is identified.
· Serve as the regional reimbursement resource for targeted customer accounts providing both technical and practical advice to avert or resolve reimbursement issues and support patient access across the journey.
· Demonstrate expert-level acumen on national and local payer payment trends, the regulatory environment, policies and relationships to assist product adoption and sales growth. Organize and lead reimbursement presentations to key decision makers in targeted accounts, with ability to navigate both public payer and private payer dynamics.
· Work with internal cross-functional partners (MA&R Payer Marketing) to assist in implementing pull-through and push-through programs designed to maximize payer coverage.
· Conduct key account reimbursement presentations to provide reimbursement information as well as local payer status updates.
· Partner with account teams to proactively provide account level business reviews to improve patient access & retention to therapy.
· Assist with other activities to support patient pull through.
· 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 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 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
· 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.
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.
