Rare Reimbursement Executive, Southwest

UCB•Phoenix, AZ

1d•Hybrid

About The Position

This is a field-based position that requires up to 75% daily and overnight travel covering Arizona & Nevada and is designed to support Pacific and Mountain Time Zones. The Rare Reimbursement Executive will ensure that appropriate patients have access to UCB rare disease products and Patient Services. They will also provide ethical commentary on local, regional, and national payer coverage and their pharmacy and medical policies to all engaged sites of care. The role requires leveraging knowledge in the market access and reimbursement journey encompassing procurement, payer policies and coverage, benefit design, prior authorizations, appeals, exceptions, denials, coding and payer payment guidelines, site of care regulation/requirements, understanding of coding guidelines with demonstrated knowledge of the complex payer environment. The executive will relay detailed benefit information in order to maximize the Provider and Staff experience including market dynamics, coverage, billing, coding and reimbursement policies for all sites of care involved. Internally, they will work with stakeholders across Market Access, Sales, the Patient Assistance Program, Marketing and Compliance. Externally, they will work with sites of care, patients and their respective payer, specialty pharmacies and pharmacy benefit managers.

Requirements

Bachelor’s degree required
8+ years of pharmaceutical or biotech experience required
Demonstrated working knowledge of medical and pharmacy benefit reimbursement including benefit investigation required

Nice To Haves

Master’s preferred
4+ years Reimbursement/Account Management experience preferred
Excellent working knowledge of evolving reimbursement landscape and the practice management environment
Neurology or Rare Disease experience preferred

Responsibilities

Serve as a liaison to all engaged sites of care administering UCB rare disease product(s) through a patient’s medical benefit and pharmacy benefit.
Provide support to patients and accounts specific to benefit verifications, product procurement processes, reimbursement information, billing, coding, and coverage details.
Provide on-demand education, including Lunch and Learns or Dinner presentations, for office staff regarding Reimbursement and support services.
Advises all sites of care on payer specific nuances related to utilization management protocols, appeals processes and the year -end re-authorization verification process.
Work with all engaged sites of care to inform them on matters related to access and reimbursement of UCB rare disease products.
Sole point of contact for all stakeholders should a Medical Claim denial be presented by a provider.
Develop strategic coverage, access and reimbursement relationships with their local Medicare Part A/B Contractors and attends Medicare Part A/B Contractor open meetings.
Provide coverage updates, policy changes and communications to internal UCB colleagues.
Provide strategic coverage and reimbursement, benefit recertification support and marketplace feedback to internal colleagues aligned to their geographies.
Monitor, interpret, and communicate local, regional, and national payer policy updates impacting UCB Rare Disease therapies.
Provide reimbursement education and ethical commentary regarding medical and pharmacy benefit coverage, benefit design, utilization management requirements, coding practices, reimbursement methodologies, and payer policy changes.
Disseminate relevant coverage and policy updates to internal stakeholders and aligned cross-functional teams.