Access and Reimbursement Manager

Omeros•United States,

1d•$185,000 - $210,000•Onsite

About The Position

We are a fast-growing and dynamic organization seeking an Access and Reimbursement Manager to join our team. This position will work cross-functionally with Sales, Market Access, and Commercial Operations to ensure timely insights, challenges and strategies are shared. The ARM will remain current on industry best practices, key payer, reimbursement and policy activities to effectively support healthcare providers and patients. This role focuses on minimizing reimbursement barriers for patients and providers. Key activities include working directly with inpatient hospital coding and reimbursement staff, outpatient office access, coding and reimbursement staff, Patient Support Services, and other stakeholders involved in supporting patient access to Omeros products.

Requirements

BA/BS Degree with at least 7-10 years of pharmaceutical experience.
Preferred minimum of 5 years’ experience in reimbursement/payer access.
Experience with buy and bill is required.
Product launch experience in the US; experience in oncology/hematology/transplant and/or ultra-rare disease is highly desirable.
Experience with limited distribution networks, specialty pharmacy, and/or HUB models is preferred.
Advanced understanding of healthcare, payers, hospital formulary, coverage, reimbursement issues, specialty pharmacy state laws, and compliance laws and regulations.
Must have demonstrated a high level of proficiency in communication skills, critical thinking / decision-making, influence, problem solving, and impact, planning and organization.
Clinical knowledge in one or more of the follow therapeutic areas preferred: Oncology; Hematology; Blood and Marrow Transplant.
Strong background for products on the medical benefit and how that impacts reimbursement by different payer types (Commercial, Medicare, Medicaid).
Demonstrated ability to work collaboratively with Sales, Marketing, Market Access, and National Accounts teams to ensure product access.
Strong communication and educational skills with both internal and external customers that results in product access.
Demonstrates good verbal and written communication skills to provide updates, direction, information, and clarification in a timely manner.
Strong Microsoft Office skills (Excel and PowerPoint)
Strong analytical skills
The employee is required to travel 50 - 80%.
Demonstrated ability to build and maintain positive relationships with management and peers.
Operate with integrity, trust, and honesty
Ability to address and manage conflicts with internal and external customers.
Demonstrate positive working relationships through emotional intelligence at various levels of the organization.
Ability to be flexible and manage change within a dynamic growing organization and an evolving health care marketplace as needs dictate.

Nice To Haves

Product launch experience in the US; experience in oncology/hematology/transplant and/or ultra-rare disease is highly desirable.
Experience with limited distribution networks, specialty pharmacy, and/or HUB models is preferred.
Clinical knowledge in one or more of the follow therapeutic areas preferred: Oncology; Hematology; Blood and Marrow Transplant.

Responsibilities

Educate inpatient and outpatient billing, coding, office managers and other care team members on coding, claim submission, payer policies and reimbursement to optimize access to Omeros therapies.
Proactively educate accounts on patient support services and resources and partner with the HUB patient program to support efficient patient initiation and continuation of treatment across sites of care.
Monitor, analyze, and triage situations which may adversely impact patient access to therapy and provide timely feedback to internal/external customers.
Collaborate cross-functionally with Omeros field teams—including Sales, Market Access, Patient Support, and Medical—to develop and execute account strategies that support timely patient access, provide consistent education on reimbursement and established coverage criteria, and address barriers to treatment.
Execute account-specific reimbursement initiatives, educational programs, and support services that optimize patient access, strengthen customer confidence in the reimbursement process, and facilitate timely treatment for eligible patients.
Proactively communicate Omeros specific reimbursement programs, coding/billing, policies, and resources to HCP personnel related to access.
Apply strong problem-solving and time management skills to identify and implement solutions that address reimbursement and patient access challenges for healthcare providers, reimbursement professionals, and coding staff.
Establish relationships with key institution/hospital, physician office, specialty pharmacy and other personnel associated with coding, billing, support access readiness, treatment initiation, and reimbursement.
Comply with all federal/state/local laws, regulations and guidelines including but not limited to the PhRMA Code on Interactions with Healthcare Professionals as well as complying with all Omeros standards and policies relating to all job activities.
Other duties as assigned.