Access & Reimbursement Manager, Cardiovascular - IL & St Louis MO Territory - Remote

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Access and Reimbursement Manager (ARM) is a field‑based role that proactively provides in‑person or virtual education to defined accounts within their assigned geographies on a wide range of access and reimbursement topics to support product strategy. The ARM serves as the local market access expert on payer policy coverage, multi‑channel acquisition pathways, billing and coding, claims processing, reimbursement, and integration of manufacturer support programs into account workflows.

The role requires problem solving, analyzing access and reimbursement issues, and proactively communicating changes in the healthcare landscape. This remote, field‑based role covers the St. Louis, MO territory and parts of Illinois; the associate must reside within the territory or within a reasonable daily commuting distance (up to 60 miles).

• Interact within assigned accounts to support patient access within their therapeutic area product(s) providing proactive face‑to‑face education on product‑specific programs to providers and staff in order to support integration of those programs into office processes and workflows.
• Address customer questions for issues related to NPC policies on therapeutic area product ordering, payment, inventorying, and product returns & replacement in offices.
• Work with key members of therapeutic area offices (e.g., providers, administrators, billing and coding staff, claims departments, revenue cycle managers) in order to appropriately support patient access to products.
• Ability to analyze problems and offer solutions. Understand specifics and support questions associated with payer policies (e.g., utilization management, denial, and appeals), drug acquisition and inventory management, and patient / practice reimbursement (e.g., Co‑pay, administration, drug claims). Analyze account reimbursement issues & opportunities (as needed). Identifies trends at a local, regional and national level and partner with purpose internally and externally to support patient pull‑through.
• Supports pull through on local coverage decisions to enable meaningful patient access within the system. Proactively communicate policy changes or issues that could potentially affect other departments.
• Accountable for standing up NVS‑sponsored patient support programs to enable patients starting and staying on therapy (i.e., Co‑pay).
• Maintain expertise in regional and local access landscape, anticipating changes in the healthcare landscape, and act as their aligned therapeutic area product(s) reimbursement expert (as needed).
• Interface with Patient Support Center (hub) on important matters related to patient case management, including tracking cases, issue resolution, reimbursement support, and appropriate office staff education. Review patient‑specific information in cases where the site has specifically requested assistance and patient health information is available in resolving any issues or coverage challenges.
• Collaborate with aligned cross‑functional associates within NPC (see above) to share insights on customer needs and barriers for their aligned therapeutic area product(s) related to access and reimbursement.
• Maintain a deep understanding of NPC policies and requirements and perform all responsibilities with integrity and in a manner consistent with company guidance and prescribed Values and Behaviors. Handle Patient Identifiable Information (PII) appropriately (understand and ensure compliance with HIPPA and other privacy laws and regulations and internal Company compliance guidelines).
• Responsible for identifying and reporting adverse events via the established Novartis systems as per applicable processes.
• Assess access situation within the assigned geography and develop appropriate Plan of Action (POA). Communicate POA to appropriate personnel.
• Responsible for establishing preferred acquisition pathways. Educate on and support buy‑and‑bill end‑to‑end processes, workflows, and facility pull‑through in complex accounts, including scenarios of centralized and…