Reimbursement and Access Case Manager
Alkermes
Summary
The Alkermes Patient Access Services (PAS) team provides support for patients wishing to access Alkermes products. Support includes reimbursement and access education, refill reminder support, coordination to financial assistance and assistance locating follow on providers for site of care transitions. The Alkermes PAS team works with patients, healthcare providers and insurance companies. The Reimbursement and Access Case Manager (RACM) will act as the single point of contact for all customers including healthcare providers, vendor partners, insurance companies to educate and provide logistical support to access Alkermes products. They will act as the subject matter expert for all topics related to reimbursement, local and regional health plan polices, coverage requirements, pharmacy coordination and any other topics impacting product fulfillment. They will also serve as a business partner to internal Alkermes stakeholders such as sales, national accounts and field reimbursement resources. The RACM will partner with the PAS Nurse Coordinators (NC) to assist patients transitioning from inpatient to outpatient care. The hours will be 8:30-5pm.
Job description
Responsibilities
- Act as a single point of contact and subject matter expert regarding the acquisition, fulfillment and reimbursement for Alkermes products, while providing the highest level of customer service
- Develop working relationships with internal and vendor teams, needed to provide coordinated support to healthcare providers and patients
- Provide updates and account information to key internal Alkermes stakeholders such as field sales, national accounts and field reimbursement managers
- Demonstrate proficiency and full understanding of Alkermes PAS processes and database including understanding of data elements, definition of various case statuses and outcomes, case documentation requirements and the importance of meeting program metrics
- Accurately document call details, follow up actions, and any other pertinent information in the Alkermes PAS database
- Gain familiarity with reimbursement and coverage requirements for health plans within their assigned geographic territories to assist with troubleshooting and resolution of ongoing issues
- Identify and escalate customer concerns and program trends to patient access services management team and reimbursement access specialists
- Assess patient enrollment for Alkermes financial assistance programs including copay savings and patient assistance programs
- Coordinate with Alkermes PAS NC teams to assist with patient transition from inpatient/residential sites of care to outpatient treatment
- Provide back up as needed for other case managers, and members of the patient services team
- Adhere to Alkermes standard operating procedures and compliance requirements
Qualifications
- Quickly and accurately understand the need of callers seeking information
- Excellent active listening and written/verbal communication skills required to provide responses that address the specific needs of each caller, while complying to Alkermes program and compliance guidelines
- Document call details with attention to data integrity for analysis supporting business objectives
- Ability to multi task, problem solve and work independently
- Effectively plan, prioritize, execute, follow up and anticipate problems
- Manage multiple projects in fast-paced, deadline driven environment
- Work collaboratively across multiple stakeholder groups
- Prior reimbursement experience with ability to communicate complex reimbursement and fulfillment scenarios and solutions to patients and medical professionals
- Demonstrated ability to work collaboratively in a team environment and as an independent contributor
- Ability to think critically and problem solve to address customer needs and barriers to product fulfillment
- Accommodate approximately 15-20% overnight travel for: Field rides and customer site visits, Hub vendor partner site visits, Sales meetings
- Working shifts are varied to support operations from 8:30am – 8pm ET
- Some flexibility may be requested in backup situations to ensure appropriate coverage during program hours
Education and Experience
- Bachelor’s degree preferred
- Minimum of 3 years case management experience, or experience working in a reimbursement hub program preferred
- Experience working in a high volume patient services program preferred
- Extensive knowledge of health plan reimbursement requirements for specialty injectable products covered by both medical (AOB) and pharmacy benefits
- Working knowledge of the compliance and regulatory environment for manufacturers in the pharmaceutical space
- Experience and understanding importance of reimbursement hub metrics and operations in the pharmaceutical industry
- Proficiency in Microsoft Outlook, Word, Excel, and Power Point
Requirements
- Bachelor’s degree preferred
- Minimum of 3 years case management experience, or experience working in a reimbursement hub program preferred
- Experience working in a high volume patient services program preferred
- Extensive knowledge of health plan reimbursement requirements for specialty injectable products covered by both medical (AOB) and pharmacy benefits
- Working knowledge of the compliance and regulatory environment for manufacturers in the pharmaceutical space
- Experience and understanding importance of reimbursement hub metrics and operations in the pharmaceutical industry
- Proficiency in Microsoft Outlook, Word, Excel, and Power Point
- Excellent active listening and written/verbal communication skills
- Ability to multi task, problem solve and work independently
- Effectively plan, prioritize, execute, follow up and anticipate problems
- Manage multiple projects in fast-paced, deadline driven environment
- Work collaboratively across multiple stakeholder groups
- Prior reimbursement experience with ability to communicate complex reimbursement and fulfillment scenarios and solutions to patients and medical professionals
- Demonstrated ability to work collaboratively in a team environment and as an independent contributor
- Ability to think critically and problem solve to address customer needs and barriers to product fulfillment
- Accommodate approximately 15-20% overnight travel
Benefits
- Annual performance pay bonus
- Competitive benefits package
Company overview
Alkermes plc is a global biopharmaceutical company specializing in neuroscience-focused medicines for psychiatric and neurological disorders. Founded in 1987 and headquartered in Dublin, Ireland, the company maintains a significant research and development center in Waltham, Massachusetts, and a manufacturing facility in Wilmington, Ohio. Alkermes has established itself as a leader in developing treatments for complex conditions including schizophrenia, bipolar I disorder, alcohol dependence, and opioid dependence. The company's portfolio includes proprietary commercial products such as Lybalvi (olanzapine/samidorphan), Aristada (aripiprazole lauroxil), and Vivitrol (naltrexone), alongside a robust pipeline of clinical and preclinical candidates targeting neurological disorders like narcolepsy and idiopathic hypersomnia. With approximately 1,800-2,100 employees worldwide, Alkermes combines deep neuroscience expertise with sophisticated development capabilities to address traditionally overlooked or stigmatized conditions, maintaining a patient-centered approach to drug development and commercialization.