Reimbursement and Access Case Manager

Alkermes

17h•Onsite

About The Position

The Alkermes Patient Access Services (PAS) team provides support for patients wishing to access Alkermes products. Support includes reimbursement and access education, refill reminder support, coordination to financial assistance and assistance locating follow on providers for site of care transitions. The Alkermes PAS team works with patients, healthcare providers and insurance companies. The Reimbursement and Access Case Manager (RACM) will act as the single point of contact for all customers including healthcare providers, vendor partners, insurance companies to educate and provide logistical support to access Alkermes products. They will act as the subject matter expert for all topics related to reimbursement, local and regional health plan polices, coverage requirements, pharmacy coordination and any other topics impacting product fulfillment. They will also serve as a business partner to internal Alkermes stakeholders such as sales, national accounts and field reimbursement resources. The RACM will partner with the PAS Nurse Coordinators (NC) to assist patients transitioning from inpatient to outpatient care. This position would work the 11:30-8 shift.

Requirements

Excellent active listening and written/verbal communication skills required to Provide responses that address the specific needs of each caller, while complying to Alkermes program and compliance guidelines
Document call details with attention to data integrity for analysis supporting business objectives
Ability to multi task, problem solve and work independently
Effectively plan, prioritize, execute, follow up and anticipate problems
Manage multiple projects in fast-paced, deadline driven environment
Work collaboratively across multiple stakeholder groups
Prior reimbursement experience with ability to communicate complex reimbursement and fulfillment scenarios and solutions to patients and medical professionals
Demonstrated ability to work collaboratively in a team environment and as an independent contributor
Ability to think critically and problem solve to address customer needs and barriers to product fulfillment
Accommodate approximately 15-20% overnight travel for: Field rides and customer site visits, Hub vendor partner site visits, Sales meetings
Minimum of 3 years case management experience, or experience working in a reimbursement hub program preferred
Extensive knowledge of health plan reimbursement requirements for specialty injectable products covered by both medical (AOB) and pharmacy benefits
Working knowledge of the compliance and regulatory environment for manufacturers in the pharmaceutical space.
Experience and understanding importance of reimbursement hub metrics and operations in the pharmaceutical industry.
Proficiency in Microsoft Outlook, Word, Excel, and Power Point

Nice To Haves

Bachelor’s degree preferred.
Experience working in a high volume patient services program preferred

Responsibilities

Act as a single point of contact and subject matter expert regarding the acquisition, fulfillment and reimbursement for Alkermes products, while providing the highest level of customer service
Develop working relationships with internal and vendor teams, needed to provide coordinated support to healthcare providers and patients
Provide updates and account information to key internal Alkermes stakeholders such as field sales, national accounts and field reimbursement managers
Demonstrate proficiency and full understanding of Alkermes PAS processes and database including understanding of data elements, definition of various case statuses and outcomes, case documentation requirements and the importance of meeting program metrics
Accurately document call details, follow up actions, and any other pertinent information in the Alkermes PAS database
Gain familiarity with reimbursement and coverage requirements for health plans within their assigned geographic territories to assist with troubleshooting and resolution of ongoing issues
Identify and escalate customer concerns and program trends to patient access services management team and reimbursement access specialists
Assess patient enrollment for Alkermes financial assistance programs including copay savings and patient assistance programs
Coordinate with Alkermes PAS NC teams to assist with patient transition from inpatient/residential sites of care to outpatient treatment
Provide back up as needed for other case managers, and members of the patient services team
Adhere to Alkermes standard operating procedures and compliance requirements