Field Reimbursement Manager - Central

Dendreon Pharmaceuticals LLC

About The Position

The Reimbursement Account Manager (RAM) is responsible for supporting unimpeded patient access to PROVENGE within an assigned geographic area. The RAM develops and implements strategies to maximize growth opportunities and reduce reimbursement barriers by reviewing national, regional, federal, and state Medicaid payer policies. The role partners with decision makers and stakeholders at community-based urology and oncology practices, academic and community hospitals, medical centers, and clinics to address coverage, coding, and reimbursement obstacles to PROVENGE utilization. The RAM also provides market feedback to corporate leadership, educates providers and accounts on patient assistance resources and payer policies, supports the sales force on access and reimbursement matters, and serves as a resource on payer policies, reimbursement processes, practice management, Medicare and Medicaid rules, and HIPAA. The role covers multiple regions and requires significant overnight travel, estimated at 60%.

Requirements

BA or BS degree required.
At least 5 years of experience in the pharmaceutical, biotech, or life-sciences industry, including 3–5 years of healthcare coverage, coding, and/or reimbursement experience.
Experience in the buy-and-bill area of reimbursement required.
In-depth understanding of coding, coverage, and reimbursement across community, academic, hospital, and IDN sites of care, and the ability to apply this knowledge to individual customer concerns.
Broad knowledge of Medicare, Medicaid, managed care, and third-party payers.
High level of sophistication and interpersonal skills to interact with insurance company medical directors, practice administrators, CEOs, CFOs, pharmacy directors, and practice medical directors.
Ability to travel overnight across multiple regions; estimated travel is 60%.
Ability to sit or stand for extended periods.
Intermittent walking to access work areas.
Finger dexterity sufficient to use a computer and complete paperwork.
Vision sufficient to use a computer, read written materials, and complete paperwork; hearing sufficient to communicate by telephone and in person.

Nice To Haves

MBA or other advanced degree preferred.
Experience in oncology or urology specialty preferred.

Responsibilities

Remove practice reimbursement barriers by providing resources and creating access to PROVENGE related to coverage and coding.
Provide timely marketplace feedback to corporate leadership on customer coverage and reimbursement trends, competitive updates, and industry issues and opportunities.
Educate providers on patient assistance programs and other resources.
Update and educate accounts on Commercial and Government payer policies that may affect access to PROVENGE treatment.
Assist the sales force with PROVENGE coverage, coding, and reimbursement, including access, pull-through, Key Opinion Leaders, and champion development as related to coverage, coding, and reimbursement.
Develop strategies to remove reimbursement barriers and educate customers to increase reimbursement confidence.
Serve as a resource to accounts and internal Dendreon staff on local, regional, and national payer policies; reimbursement regulations and processes, including eligibility and benefit verification, pre-authorization, billing, coding, claims, and appeals or grievances; practice management; Medicare and Medicaid rules and regulations; and HIPAA.
Act as liaison between LASH and internal and external customers on coverage, coding, and reimbursement.
Record Regional Payer PROVENGE medical policies and contact information in SFDC.
Comply with OIG, FDA, and corporate policies and procedures.