Access and Reimbursement Manager

Candidate Experience site

123d • $185,000 - $210,000

About The Position

The Access and Reimbursement Manager (ARM) is a field-based position and will report to the Director of Payer Access and Reimbursement. This role focuses on minimizing reimbursement barriers for patients and providers. Key activities include working directly with inpatient hospital billing/reimbursement staff, outpatient office billing/coding support staff, third-party vendors (HUB, Patient Assistance Programs, etc.), and other stakeholders involved in supporting patient access to Omeros products. This position will work cross-functionally with Sales, Marketing, Market Access, and Commercial Operations to ensure timely insights, challenges and strategies are shared. The ARM is expected to have a deep working knowledge in the reimbursement landscape, payer reimbursement processes, and be proficient in the latest industry reimbursement best practices, trends and news.

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 injectable or infused oncology/hematology or specialty products that are administered 'incident to' a physician service (reimbursed as a medical benefit) is required; buy and bill experience required.
• Product launch experience in the US; experience in oncology/hematology/transplant and/or ultra-rare disease is highly desirable.
• Experience with drugs with restricted (limited or exclusive) 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 following 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).
• Ability to be flexible and manage change within a dynamic growing organization and an evolving health care marketplace as needs dictate.
• Strong analytical skills.

Nice To Haves

• 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.

Responsibilities

• Educate inpatient and outpatient billing, coding, office managers and other care team members on coding, billing, coverage and reimbursement to optimize access to Omeros therapies.
• Collaborate with members of the Omeros field team—including Transplant Clinical Account Managers, Market Development Managers, and Sales Business Directors and National Payer Account Managers—to develop and execute overall account strategies, ensuring consistent and aligned education on reimbursement and patient access.
• Liaise with the entire Market Access department including HUB Services, distribution services, other Omeros staff, and inpatient/outpatient staff to identify and resolve trending issues regarding patient access to Omeros products.
• Identify and develop short-term & long-term strategic account plans, programs, services focusing on increasing education at the HCP level regarding reimbursement / access methods for patients.
• Proactively communicate Omeros specific reimbursement programs, coding/billing, policies, procedures, and resources to HCP personnel related to access; the majority of time is spent on customer engagement.
• Monitor, analyze, and triage situations which may adversely impact patient access to therapy and provide timely feedback to internal/external customers.
• Collaborate with Patient Services (HUB), Specialty Pharmacy, and other reimbursement entities on individual case management needs related to HCP education on reimbursement issues.
• Collaborate closely with Field Payer teams on coverage policy developments.
• Establish relationships with key institution/hospital, physician office, specialty pharmacy and other personnel associated with coding, billing, reimbursement and provide reimbursement-related support (Coding, Billing, Payment, Policy).
• 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.

Benefits

• Competitive total compensation package designed to support the lives of our employees and their families.
• Wage scale for Access and Reimbursement Manager position is ($185,000 - $210,000).
• Medical, dental, vision, life insurance, and a 401(k) plan with a company match.
• Employees accrue three weeks of vacation and 80 hours of sick time on an annual basis.
• Twelve paid holidays throughout the calendar year.
• Eligible for incentive and stock options.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Bachelor's degree