Field Reimbursement Access Manager Oncology (Philadelphia/South Jersey)

Job Description

An important aspect of patient unmet need includes helping them start and stay on their medicine for the best chance at treatment success. The Patient Engagement and Customer Solutions (PECS) organization serves patients, during their treatment journey with Janssen therapies, to help overcome challenges to fulfillment, on-boarding, and adherence. The Field Reimbursement Manager (FRM) is responsible for serving as the primary field-based lead for education, assistance, and issue resolution with healthcare providers (HCPs), and their office staff, with respect to patient access to J&J Oncology therapies. This role involves investing time (up to 50%) on-site with HCPs, assessing their education needs and facilitating collaboration with various stakeholders.

Primary Responsibilities

• Educate HCPs on reimbursement processes, claims submissions, procedures, and coding requirements of payer organizations (local payers, government payers, etc.) for core and launch products.
• Collaborate with field support team members such as sales representatives and key account managers and serve as reimbursement expert for the local team.
• Act with a sense of urgency to address critical access and affordability issues for patients.
• Partner with managed care colleagues to understand current policies and potential future changes.
• Conduct field-based reimbursement and access support, education and creative problem-solving aligned to FRM Rules of Engagement.
• Build strong, trust-based relationships with customers in all assigned Oncology accounts.
• Manage territory logistics, routing, and account business planning.
• Maintain and grow knowledge of national, regional, local, and account market dynamics including coverage and coding requirements.
• Grow the knowledge of hub and specialty distribution channels to improve practice and patient support needs.
• Collaborate with internal J&J departments such as marketing, sales, medical science, SCG, IBG, HCC, and PECS.
• Serve as subject matter expert regarding education and insights on access and affordability solutions across multiple payer types and plans (i.e., Medicare, Medicaid Managed Care, Commercial).
• Execute business in accordance with the highest ethical, legal, and compliance standards, including timely and successful completion of all required training.

Market Access Expertise

• Extensive knowledge of medication access channels (i.e., pharmacy and medical benefit including buy & bill and/or assignment of benefit (AOB) across multiple sites of care.
• Remains current on and anticipates changes in product coverage and access knowledge, marketplace conditions, and stakeholder practices to deliver the most effective delivery of approved materials.
• Understands and adapts to the changing healthcare ecosystem to customize resource and messaging to HCPs and HCP staff.

Required Qualifications

• Bachelor's degree (preferably in healthcare or business/public administration). An advanced business degree (MBA), or public health (MPH) is preferred.
• Minimum of 5 years of relevant professional experience.
• Account Management and/or Reimbursement experience working in the provider office setting, building strong customer relationship.
• Demonstrated expertise with both pharmacy and medical/buy & bill benefit design, coding, billing, prior authorizations, office operations, and appeals processes.
• Reimbursement or relevant managed care experience (revenue cycle, buy-and-bill, prior authorization, coding, and appeals processes).
• Ability to establish relationships, collaborate, and influence across a matrix organization.
• Problem-solving ability to navigate challenging access scenarios and identifies solutions in a timely and efficient manner.
• Superior communication skills (written and verbal) and efficient follow-through.
• Experience in working with patient support HUB services.
• Valid US driver's license and a driving record in compliance with company standards.
• Permanent residence in the listed territory.

Preferred Qualifications

• Oncology disease state experience.
• Advanced degree and/or relevant certifications in prior authorization and/or billing and coding.
• Strong market access acumen as it relates to payer approval processes and business acumen.
• Understanding of Medicare, Medicaid, and private payer initiatives affecting reimbursement of pharmaceutical and biotechnology products.
• Excellent technical knowledge and expertise in payer policy, including all elements of reimbursement (coding, coverage, and payment) is preferred.
• Demonstrated competence with salesforce.com CRM use, Microsoft Word, and Excel.
• Demonstrated commitment to learning emerging technologies, such as AI, through exploration, iteration, and apply new tools over time.

This role involves travel up to 75% of the time.