Patient Access Manager II

Job Purpose

The Patient Access Manager (PAM) II is a non-sales regional, field-based position that will work directly with patients, families, and their provider(s) to address barriers, through information and education, to patient starting on therapy and staying on therapy, if appropriate. This role demonstrates superior customer facing skills working directly with multiple external and internal stakeholders including patients, prescribers, and advocacy groups. The PAM II is a subject matter expert in navigating insurance coverage and assisting in securing reimbursement through prior authorizations and appeals. The PAM II will also provide patient education, disease state and product education as well as general support for the patients and their caregivers. This role will appropriately interact and engage internal and external with teams but will serve as the point person responsible for identifying and resolving issues impacting treatment initiation and ongoing therapy. This position will also serve as the primary source for all regional patient advocacy activities. The PAM II will leverage his/her overall business acumen, therapeutic area knowledge, and patient access expertise to provide developmental guidance to their Patient Access Manager I colleagues.

Essential Job Functions

• Upon confirming a valid consent, meet and work closely with patients/families to work through the steps required to gain access to therapy (insurance navigation, understanding of payer policy and procedure for prior authorization, denial appeals, disease and product education, site of care logistics, and other support services).
• Provide education and information through the prior authorization/appeal processes and coordinate the delivery of appropriate documentation to achieve and maintain coverage.
• Complete a comprehensive assessment of the individual needs of the patient. This assessment will include understanding the individual’s payer policies, plan designs, including Medicaid coverage if applicable, as well as the healthcare system local to the patient.
• Develop and offer solutions to the family, when necessary, that may also include communication of alternative insurance options and how families can best connect to available resources including charitable organizations such as PAF and NORD.
• Appropriately interact with and engage internal teams including commercial and medical and external teams including patients and/or their caregivers; payers; specialty pharmacy, physician offices, charitable organizations and patient advocacy organizations.
• Serve as the point person responsible for identifying and resolving issues impacting treatment initiation and ongoing therapy.
• Provide support for the caregivers and collaborate with them in a way that allows for forward progress.
• Be knowledgeable of any changes in the payer access environment to identify issues that may impact access and communicate information appropriately to colleagues.
• Facilitate rare disease network/relationships through local advocacy groups, rare disease related events, and attending national conferences.
• Support organizing and participating in patient-to-patient meetings and programs.
• Maintains up-to-date knowledge on product resources available to support patients/caregivers at the regional level and applies this knowledge in a way that supports patient care.
• Offers subject matter expertise on trends, compliance, and other disciplines that impact the Patient Access role to help elevate the overall performance of the Patient Access team.
• Coaches and mentors new members of the team.

Skills and Qualifications

• BS/BA or relevant four-year degree. Advanced degree preferred.
• Minimum of 5 years’ total business experience in the healthcare or biotech industry with at least 3 years’ field-based experience in account management, sales, or field reimbursement.
• Experience working directly with patients and caregivers and in rare disease experience a plus.
• A deep understanding of insurance products and medication reimbursement process with a successful track record in field reimbursement, clinical education or in pharmaceutical sales/management of products that required significant payer and reimbursement involvement.
• Seasoned, mature pharmaceutical/biotech professional with a comprehensive understanding of field / patient reimbursement, charitable funding, non-profit organizations.
• Experience leading cross functionally and influencing without authority.
• Case management experience in rare disease a plus including experience dedicated to assisting patients/caregivers.
• Must be familiar with relevant legal and regulatory environment in biotech industry such as the Food Drug and Cosmetic Act, Anti-Kickback Stature, HIPAA and other patient privacy guidance and regulations.

Competencies

Written and Verbal Communications, Problem Solving, Presentation skills, Teamwork & Collaboration, Customer Service focus, Teamwork & Collaboration, Adaptability, Professionalism.

Working Conditions

Position may require periodic evening and weekend work, as necessary to fulfill obligations. Periodic overnight travel. Ability to Travel up to 10%.