Associate Director, Access & Reimbursement -Radioligand Therapies (RLT) Colorado

Job Description Summary

The Associate Director, Access & Reimbursement (ADAR) is a field-based role that proactively provides in person (or virtual as needed) education to defined accounts within their assigned geographies on a wide range of access and reimbursement topics and needs (see below) in support of aligned product(s) strategy. ADARs primarily focus on accounts with increased process and workflow complexity, typically including centralized and decentralized systems of care, integrated delivery networks, academic medical institutions, large multi-provider specialty practices, and alternate sites of care.

ADARs will serve as the patient access and reimbursement lead in business-to-business conversations with account executives. The ADAR role is responsible for managing the pull-through of access and reimbursement strategy and downstream operations within their aligned accounts. ADARs are expected to have deep expertise in communicating requirements and addressing barriers associated with local payer policy coverage, multi-channel acquisition pathways, billing and coding education (as needed), claims processing, reimbursement, and integration of manufacturer support programs into a range of account workflows. ADAR will continually need to demonstrate a keen ability to problem solve and manage multiple projects.

ADARs 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. ADARs 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).

This person will support Colorado.

Job Description

Key responsibilities:

• Interact with large, complex accounts to support patient access within their aligned therapeutic area product(s), proactively provide face-to-face education on programs to providers and staff in order to support integration of those products into office processes and workflows.
• Address customer questions for issues related to NPC policies on therapeutic area products ordering, payment, inventorying, and product returns & replacement in offices.
• 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 HIPAA and other privacy laws and regulations and internal Company compliance guidelines).
• Responsible for identifying and reporting adverse events via the established Novartis systems as per applicable processes.
• Work with key members of therapeutic area offices (e.g., executives, 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 patient reimbursement and provide support on reimbursement issues with third party payers at the provider-level. Analyze account reimbursement issues (as needed). Identifies trends at a local, regional and national level and partner with purpose internally and externally to support patient access to Novartis medicines
• Supports pull through on local coverage decisions to enable meaningful patient access within the system. Proactively communicate policy changes or issues that could potentially affect other departments.
• Accountable for informing customers on NVS-sponsored patient support programs to help enable patients starting and staying on therapy (i.e., Co-pay).
• 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).
• Interface with Patient Support Center (hub) and Access & Reimbursement Managers on important matters related to patient case management, including tracking cases, issue resolution, reimbursement support, and appropriate office staff education.
• 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.

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 educating HCPs using approved materials regarding acquisition pathways for Novartis products. Educate on 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 site of care for administration.
• Educates relevant stakeholders on logistics related to ordering, payment, inventory, and product returns & replacement.
• Analyze reimbursement issues, anticipating changes in the healthcare landscape, and act as the designated reimbursement expert for offices and field teams.
• Accountable for engagement with non-prescribers in regards to Novartis medicines, for example pharmacy, system leadership, financial counselors, office administrators, revenue cycle managers, etc.

Radioligand Therapies Specific

• The ADAR will be a critical partner to the Novartis Patient Support (NPS) customer engagement team on supply capacity, site procurement eligibility, as well as a customer facing resource for communications on orders and logistics.
• Understand RLT key priorities in core disease areas, financial goals, and site initiatives to influence overall account and regional business strategies.
• Assess and understand site and/or other appropriate organizations’ level of readiness for procurement of nuclear medicines and billing to facilitate orders for products and so that they can engage and educate on procurement systems and processes, access, and reimbursement. Be able to understand where gaps in procurement exist and work with Cross-Functional partners to resolve.
• Partner with the customer engagement teams to assist the communication and facilitation of procurement and logistics with both the site and the local field teams. (e.g., procurement, logistics processes and timing, and education regarding available rebate offerings, as appropriate) as well as patient-specific support (benefit verification, PA, appeals, copay programs and applicable rebate offerings)
• Partner with Market Access to support follow up to help ensure completion of purchase agreements & GPO forms by acting as liaison for RLT Access Lead (RAL) for new site onboarding.
• Responsible for supporting treatment site onboarding to include RAM license, W9, & PRD preferences
• Major accountabilities apply to therapy, diagnostic and theragnostic treatment centers.

Key Performance Indicators

• Overall customer satisfaction and awareness related to designated therapeutic area products programs and reimbursement support.
• Education of key customers in therapeutic area offices (i.e. specialists, billing staff, reimbursement staff) in order to assist with therapeutic area products integration and improve patient access in a manner consistent and compliant with company policies and requirements.
• Ensure customers on assigned target list and within assigned geography are aware of and know how to utilize available programs to support therapeutic area products access for patients.
• Adherence with NPC policies, laws and regulations.

Minimum Requirements

• Bachelor’s Degree required.  Business and/or biological science education preferred. Advanced degree preferred. 
• 5+ Years of experience in pharmaceuticals / biotech industry focused in Patient Services, Market Access, Sales, and/or account management. With 2 of those years being in a Patient Services practice support role for a specialty product(s).
• Experience working with highly complex practices and/or health systems to establish access and acquisition pathways.
• Strategic account management experience using a proactive approach to anticipate access hurdles impacting accounts and patient access.
• Deep expertise and experience integrating manufacturer-sponsored patient support programs.
• Experience with specialty products acquired through Specialty Pharmacy networks
• Knowledge of reimbursement pathways (specialty pharmacy, buy-and-bill, retail)
• Possess a strong understanding of Commercial payers, Medicare plans and state Medicaid in geographic region.
• Must live within assigned territory.
• Ability to travel and cover geography, at least 50% travel required, based on geography and territory / targeting make up.
• 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.

Preferred Qualifications:

• Experience leading and delivering presentations to C-level account executives.
• Strong ability to work cross functionally with such functions as Field Sales, Marketing, Market Access, Public Affairs, State & Government Affairs, Trade, Specialty Pharmacy Account Management and applicable third-party affiliates.
• Expertise in therapeutic area practice dynamics and common reimbursement and product program support-related needs.
• Strong capabilities in the areas of customer focus, collaboration, business acumen, communication, and presentation skills.
• This position requires significant use of a company provided vehicle and maintaining good driving record
• This is a field-based customer engaging position
• Control business expenses related to field activities (i.e. travel, customer meetings) and provide timely expense reports to manager.

EEO Statement:

The Novartis Group of Companies are Equal Opportunity Employers. We do not discriminate in recruitment, hiring, training, promotion or other employment practices for reasons of race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, marital or veteran status, disability, or any other legally protected status. 

Accessibility and reasonable accommodations

The Novartis Group of Companies are committed to working with and providing reasonable accommodation to individuals with disabilities. If, because of a medical condition or disability, you need a reasonable accommodation for any part of the application process, or to perform the essential functions of a position, please send an e-mail to [email protected] or call +1(877)395-2339 and let us know the nature of your request and your contact information. Please include the job requisition number in your message.

Salary Range

$160,300.00 - $297,700.00

Skills Desired

Analytical Thinking, Cross-Functional Collaboration, Employee Development, Finance, Health Economics, Health Technology Assessment (HTA), Innovation, Inspirational Leadership, People Management, Process Management, Project Management, Public Affairs, Real World Evidence (RWE), Regulatory Compliance, Risk Management, Value Propositions