Senior Therapy Access Manager - US

Primary Duties and Responsibilities

• Execute institutional and field access strategy for their responsible geography
• Identify and educate key clinic/institution stakeholders on reimbursement dynamics, patient support services, distribution model, and payer requirements to gain access to the product
• Partner with the Sales Account Managers, Clinical Coordinators, and Patient Support Services Hub to ensure HCPs can navigate patient access needs; lead proactive touchpoints with internal matrix partners to keep all parties informed for relevant account planning purposes
• Conduct/monitor complex Benefits Investigations, provide results to clinics, and educate on Prior Authorization processes. Monitor PA process and provide additional education as needed.
• Act as a liaison between the patient support services hub and the HCP clinic to educate providers on patient support programs, including coverage authorization guides, Co-Pay assistance programs and other hub and patient support services
• Provide live one-on-one educational support to HCP and/or office staff and address questions about coverage requirements, including education on the payers' coverage authorization requirements and process
• May reactively interact with patients for complex access issues as needed while maintaining compliance standards at all times
• Champion compliance and ethical standards, mentoring junior team members on best practices within a regulated environment
• Analyze payer trends and institutional feedback to inform strategic adjustments and support escalation pathways for challenging cases
• Educate HCPs, office staff, and institutions on payer issues, policies/guidelines, trends, common reasons for PA delays, denials, and appeal processes
• Review escalated individual patient cases to identify and address any coverage barriers; proactively scan payer policies tailored to each clinic's needs and provide regular updates based on market dynamics
• Travel up to 50% to support above responsibilities, as needed; represent team at national meetings as appropriate

Experience and Educational Requirements

• 7+ years of Pharmaceutical or Healthcare industries, preferably including 5+ years in access/reimbursement
• Bachelor's degree required
• Proven track record of supporting HCPs and office staff in seeking access/reimbursement that required significant payer and reimbursement support
• Experience with both 'buy and bill' and Specialty Pharmacy distribution pathways for specialty oral and injectable medications
• Strong knowledge of the payer environment, including government and commercial payers, assignment of benefits, letter of agreements, accumulators, maximizers, manufacturer patient support programs
• Ability to professionally interact with customers – HCPs, office staff, institutions
• Excellent communication skills; strategizes proactive solutions for keeping stakeholders informed
• Solid knowledge of patient support programs including HUB programs, co-pay assistance programs, and nurse educator support
• Track record of effective collaboration in a highly matrixed environment
• Strong knowledge and understanding of Compliance with HIPAA regulations, OIG guidance, Advertising and Promotion requirements, the Anti-Kickback Statute, and applicable policies, best practices, and guidelines
• Strong planning and organization skills including OFFICE suite of productivity tools
• Rare Disease, Specialty, and Launch experience

Preferred Experience

• Experience working within Salesforce.com
• Experience with REMS product(s)
• Experience with limited distribution product(s)

Minimum Skills, Knowledge, and Ability Requirements

• Strong analytical skills
• Strong organizational skills; attention to detail
• Ability to travel overnight
• Ability to schedule individual work-related travel (air, hotel, rental car as needed)
• Ability to utilize own car for travel
• Technical knowledge of healthcare from a patient and provider perspective (miscellaneous codes, billing codes, appeals process)
• Must be willing to travel up to 50% of the time. Territory includes entire US and Puerto Rico
• Bilingual highly desirable
• Nursing experience a plus