Regional Director, Field Reimbursement, North Region

Apellis Pharmaceuticals • Waltham, MA

293d

About The Position

Reporting to the National Director of Reimbursement, the Regional Director, Field Reimbursement will be responsible for the development and implementation of the site of care reimbursement and patient access strategy for Apellis' Ophthalmology portfolio within their assigned region. This individual will lead a team of 8 Field Reimbursement Managers responsible for supporting retina practices with patient access to Apellis' Ophthalmology products. This individual will use their experience and technical knowledge to help their team in identifying, understanding, and addressing reimbursement challenges that impact patient access to therapy obtained through both 'buy and bill' and specialty pharmacy. As a member of the Field Leadership Team, the Regional Director, FRD will work with cross-functional partners (i.e., Marketing, Sales, Advocacy, Account Management, Patient Services, and Medical) to create and deploy solutions within their region that drive patient access, ensuring team alignment in overall execution of strategy.

Requirements

• Bachelor's degree required; MBA an advantage.
• 12+ years of commercial experience in the pharmaceutical or biotech industry.
• 5+ years of experience in Healthcare Provider Reimbursement, Payer Relations or Account Management.
• 4+ years management experience demonstrating the ability to build and sustain high performing teams.
• Ophthalmology experience strongly preferred.
• Deep knowledge of 'buy and bill', Medicare Part B, medical benefit, and their associated reimbursement pathways.
• Technical expertise in ICD 10, HCPCS and CPT coding along with payer policy and reimbursement.
• Ability to manage and influence in a highly matrixed environment.
• Experience in developing and directing the implementation of strategic, high-impact business plans.
• Exemplary presentation skills.
• A self-starter with the ability to prioritize needs and drive results.
• Strategic thinker with exceptional business acumen.
• Advanced understanding of compliance with OIG & regulatory requirements.

Nice To Haves

• Passion for the patient journey and addressing patient needs.

Responsibilities

• Lead a field team and provide clear direction to the Field Reimbursement Managers.
• Foster a high-performance and forward-thinking culture in line with Apellis' values.
• Proactively anticipate and coach, mentor, train, and influence team members.
• Ensure FRM team has the required knowledge to be viewed as the most knowledgeable in the retina space.
• Monitor FRM adoption of HUB services and patient support programs at the practice level.
• Monitor CMS and commercial insurer policies and keep abreast of trends in reimbursement.
• Require FRM team to have expert knowledge of coverage landscape within each aligned geography.
• Establish and support local market diagnostics related to outlier payers.
• Pull through national strategy at regional level to enable execution.
• Lead specific national strategies and tactic development.
• Establish expectations for collaboration with cross-functional partners.
• Drive the execution of quarterly business reviews at practices.
• Develop FRMs into future leaders through coaching and feedback.
• Work in lockstep with Reimbursement Marketing, Corporate Accounts, Sales and Patient Services.
• Provide feedback to Government Affairs/Public Policy and Account Management teams.
• Maintain a national perspective in decision-making and lead projects at a national and regional level.
• Iterate on and execute a reimbursement learning & development plan.
• Interface with various departments to ensure compliance with corporate and industry policies.
• Provide input to the strategic growth of the functional FRM team.
• Participate in the annual brand strategy and tactical plan from an access & reimbursement perspective.
• Implement a process for best practice sharing across divisional teams.

Benefits

• 401(k) plan with company match.
• Inclusive family building benefits.
• Flexible time off.
• Summer and winter shutdowns.
• Paid family leave.
• Disability and life insurance.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Industry: Professional, Scientific, and Technical Services
• Education Level: Bachelor's degree