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Mallinckrodt Pharmaceuticals · 19 hours ago

Field Reimbursement Manager (New Jersey)

Bridgewater, NJ

Full-time

Onsite

Senior Level

$166K/yr - $188K/yr

5+ years exp

Mallinckrodt Pharmaceuticals is seeking a Field Reimbursement Manager to be a critical member of the Keenova Access and Reimbursement Team. The FRM will minimize access and reimbursement barriers for patients and providers by providing education and support related to reimbursement processes and specialty therapies.

Biotechnology

Responsibilities

Subject matter expert for all reimbursement/access and acquisition logistical aspects of a high touch biologic medication for an orphan disease and testosterone products with multiple acquisition options within a changing payer landscape. This includes: payer policies, prior authorization requirements, denial and appeal process, peer to peer, and other education required to navigate access for the appropriate patients

Assists HCP offices with questions related to Buy/Bill BI management. Educate/Assist with Specialty Pharmacy (SP) understanding, expectations and logistics. Continually educate office staff on appropriate steps, educate on the importance of chart documentation, keep offices up to date on payer policies for Keenova products and triage issues to the appropriate HUB and SP

Primary responsibilities include:

Managing patient assistance and reimbursement support services offered to providers and related to patient access to buy/bill products

Coordinating with Keenova’s patient support services program representatives

Educating office staff on the use of Buy/Bill products, patient assistance and reimbursement support services

Participating in sales training related to product reimbursement

Utilizing data to critically think through acquisition challenges from a variety of outlets including SP, Specialty Distributors and Title sales

Assist new offices from a reimbursement perspective to inform them about reimbursement issues as well as providing education on various MARC approved resources pertaining to reimbursement, acquisition and coding

Act in a compliant manner at all times

FRMs work closely with the external and internal customers to trouble shoot any SP related issues. FRMs work closely with their NAE partner to manage any customer related issues directly with the SP’s

SP experience is critical. Each FRM should be an expert SP logistics and operations

FRMs must be able to analyze data and know how to make that data into actionable steps to facilitate patient access to Keenova products

Work closely with SP’s to understand logistical issues that arise and provide MARC approved resources and programs to facilitate patient access as well as communicate with SP’s to find resolutions to issues that arise at the SP

Identify gaps in knowledge of accounts from a SP process and help provide education for the account and physician

Develop short and long term account plans for key accounts with the goal of smoothing out the process of acquiring drug to optimize acquisition and patient journey

Consistent, reliable, timely and high-quality support of the field, as well as all other internal commercial functions

Strong leadership role to the field teams by establishing a solutions oriented approach, working with your Sales Representatives/ASMs to build and execute local plans to overcome barriers to Buy/Bill products access. Specific examples include:

Identify in conjunction with the field, specific targeted accounts where the FRM will assist with product acquisition or SP dispense

Partner with the ASMs to build local business plans; participate in district business reviews as the expert resource on the reimbursement landscape from regional, district, state and local perspective

Provide the teams with actionable feedback (across the organization) on support programs such as the Helpline, copay card, SPP performance, so as to guide changes to improve access

Help educate the internal customers on managed market dynamics specific to SP’s/SD’s as well as local payor issues-needs. Track customer trends in order to help inform internal business decisions, e.g. Health care policy changes

Proactively use business analytics to understand common logistical issues in top accounts and proactively develop plans for education and to find solutions for better patient access to all supported specialty products. Ensure alignment with ASM and District Strategy

Provide support to sales representatives, ASMs and Internal Stakeholders on rules of engagement to educate and further clarify what is appropriate

Works with the field to identify potential payer advocates and supports the National Account Management team on issues relating to medical policy development and execution at the HCP level

Ensure all Keenova approved promotional speakers have an in-depth understanding of billing/coding, logistics and payer coverage

Qualification

Biopharma experience3rd party reimbursementPatient access supportBuy & bill pathwaysCommercial payer policyMedicare billing/codingSales managementAccount managementPresentation skillsCollaboration skills

Required

BS or equivalent is required; MBA or advanced degree preferred

5-7 years of relevant experience in the Biopharma industry required

Three years' experience in 3rd party reimbursement and managed care experience

Significant experience in patient access support, i.e., copay programs, HUB management, payer experience, etc

Superb knowledge and operationalizing experience of buy & bill and SP pathways

Previous experience working with vendor relationships required

Previous experience managing customer interactions required

All newly hired FRMs should enter at this level regardless of their tenure or experience elsewhere

Systemic understanding of the global payer and distribution environment, in particular, physician administered biologics in the U.S

Understanding of coverage, coding (diagnostic, procedural and product), payment and reimbursement requirements and policies

Knowledge/expertise in commercial payer policy

Knowledge/expertise in Local Coverage Determinations (LCDs) per each regional MAC for all Keenova products

Knowledgeable on Medicare billing/coding and appeal process. ASP, WAC as well as Sequestration; interpret and understand Medicare EOBs and CMS 1500 forms

Understands the legislative, legal and regulatory environments and anticipates potential impact to Keenova

Solid understanding of coverage policy creation, interpretation, and management

Significant sales experience in the biologic (injectable) market

Possess a strong understanding of commercial payers, Medicare Part B and D and Medicaid; particularly in assigned geography

Ability to have payer conversations with commercial and government payers, drawing on the understanding of Keenova products, payer policy appeals process, and the payer landscape

Leverage all resources (Tableau and other portals) to develop and execute account support and educate sales colleagues

Ability to synthesize clinical literature and target product profile in order to understand implications for value to payers, patients and health care providers and Keenova

Superior verbal, written, and presentation skills to effectively convey strategic and technical market access information, with an ability to condense complex information into concise outputs and direction

Ability to balance external stakeholders' wants with Keenova's needs

Hands–on operational reimbursement experience – in-house and outsourced experience required

Demonstrated ability to work with multiple stakeholders in a collaborative and constructive manner. Establishes relationships with appropriate field personnel, accounts, payers and vendors

Model Keenova's vision and core values and encourages others to foster a culture of compliance

Conduct business at the c-suite level for large hospital systems and can address more routine policy and State Medicaid and Medicare problems

Significant travel involved