Access & Reimbursement Manager Immunology - Remote - Bakersfield, CA

Location: Remote (field)

ARM will serve as the key contact and lead for access and reimbursement support-related matters and is responsible for being the local market access expert on payer policy coverage, multi-channel acquisition pathways, billing and coding, claims processing, reimbursement, and integration of manufacturer support programs into a range of account workflows. Additionally, the ARM will continually need to demonstrate a keen ability to problem solve, analyze access and reimbursement issues and opportunities, and proactively communicate changes in the healthcare landscape.

ARM will partner closely with other Novartis Pharmaceuticals Corporation (NPC) field associates, including Customer Engagement (Sales) and Market Access, representing NPC with the highest integrity in accordance with NPC Values and Behaviors. ARM will also be required to coordinate and communicate cross-functionally within NPC (e.g., Patient Support Center, Customer Engagement, Marketing, Market Access, Public Affairs, State & Government Affairs, Trade, Specialty Pharmacy Account Management, and other applicable third-party affiliates).

Key Responsibilities:

• Interact within assigned accounts to support patient access within their therapeutic area product(s) providing proactive face-to-face education on product-specific programs to providers and staff in order to support integration of those programs into office processes and workflows.
• Work with key members of therapeutic area offices (e.g., providers, administrators, billing and coding staff, claims departments, revenue cycle managers) in order to appropriately support patient access to products.

• Ability to analyze problems and offer solutions. Understand specifics and support questions associated with payer policies (e.g., utilization management, denial, and appeals), drug acquisition and inventory management, and patient / practice reimbursement (e.g., Co-pay, administration, drug claims). Analyze account reimbursement issues & opportunities (as needed). Identifies trends at a local, regional and national level and partner with purpose internally and externally to support patient pull-through.
• Maintain expertise in regional and local access landscape, anticipating changes in the healthcare landscape, and act as their aligned therapeutic area product(s) reimbursement expert (as needed).
• Collaborate with aligned cross-functional associates within NPC (see above) to share insights on customer needs and barriers for their aligned therapeutic area product(s) related to access and reimbursement.
• Maintain a deep understanding of NPC policies and requirements and perform all responsibilities with integrity and in a manner consistent with company guidance and prescribed Values and Behaviors. Handle Patient Identifiable Information (PII) appropriately (understand and ensure compliance with HIPPA and other privacy laws and regulations and internal Company compliance guidelines).

Buy and Bill Specific

• Assess access situation within the assigned geography and develop appropriate Plan of Action (POA). Communicate POA to appropriate personnel.
• Responsible for establishing preferred acquisition pathways. Educate on and support buy-and-bill end-to-end processes, workflows, and facility pull-through in complex accounts, including scenarios of centralized and decentralized acquisition, and use of alternative channels such as white bagging, clear bagging, brown bagging, and alternate sites of care for administration.
• Educates relevant stakeholders on logistics related to ordering, payment, inventory, and product returns & replacement.
• Analyze reimbursement issues & opportunities, anticipating changes in the healthcare landscape, and act as the designated reimbursement expert for offices and field teams.
• Accountable for engagement with non-prescribers, for example pharmacy, system leadership, financial counselors, office administrators, revenue cycle managers, etc.

What You’ll Bring to the Role:

Education: Bachelor’s Degree required. Advanced degree preferred.

Essential Requirements:

• Minimum three to five years' experience in public or private third-party Reimbursement arena or pharmaceutical industry in managed care, clinical support, or sales.
• Experience with specialty pharmacy products acquired through Specialty Pharmacy networks or specialty distributors (buy and bill)
• Experience with coding, billing and in office support programs
• Prior account management experience or prior experience with complex accounts (Payer landscape, high patient volume, large systems)
• Specialty pharmacy experience required (ability to teach an office the entire process from script to injection)
• Establishing relationships within a practice by working closely with them to help remove Reimbursement barriers to specialty products for their patients
• Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare Parts B and D (Medical and Pharmacy Benefit design and coverage policy) a plus
• Knowledge of Managed Care, Government, and Federal payer sectors, as well as Integrated Delivery Network/Integrated Health Systems a plus
• Ability to travel and cover large multistate geography territories, at least 50% travel required, based on geography and territory / targeting make up; Must live within assigned territory.
• Superb knowledge of buy-and-bill reimbursement pathway.
• Experience working with established injection networks.

Why Novartis: Our purpose is to reimagine medicine to improve and extend people’s lives and our vision is to become the most valued and trusted medicines company in the world. How can we achieve this? With our people. It is our associates that drive us each day to reach our ambitions. Be a part of this mission and join us! Learn more here: https://www.novartis.com/about/strategy/people-and-culture  

You’ll Receive: You can find everything you need to know about our benefits and rewards in the Novartis Life Handbook. https://www.novartis.com/careers/benefits-rewards

Commitment to Diversity & Inclusion: Novartis is committed to building an outstanding, inclusive work environment and diverse teams representative of the patients and communities we serve.

Novartis Compensation and Benefit Summary: The pay range for this position at commencement of employment is expected to be between $144,000.00 and $216,000.00/year; however, while salary ranges are effective from 1/1/24 through 12/31/24, fluctuations in the job market may necessitate adjustments to pay ranges during this period.  Further, final pay determinations will depend on various factors, including, but not limited to geographical location, experience level, knowledge, skills and abilities. The total compensation package for this position may also include other elements, including a sign-on bonus, restricted stock units, and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered. Details of participation in these benefit plans will be provided if an employee receives an offer of employment. If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

Join our Novartis Network: If this role is not suitable to your experience or career goals but you wish to stay connected to hear more about Novartis and our career opportunities, join the Novartis Network here: https://talentnetwork.novartis.com/network

 Field roles with a dedicated training period only:

The individual hired for this role will be required to successfully complete certain initial training, including home study, in eight (8) or fewer hours per day and forty (40) or fewer hours per week.

Driving is an essential function of this role, meaning it is fundamental to the purpose of this job and cannot be eliminated. Because driving is an essential function of the role, you must have a fully valid and unrestricted driver’s license to be qualified for this role. The company provides reasonable accommodations for otherwise qualified individuals with medical restrictions if an accommodation can be provided without eliminating the essential function of driving.