Director, Reimbursement and Patient Services
The Director Reimbursement Patient Services will personally oversee the management of reimbursement support services for attaining prescription orphan drug benefits and co-pay assistance for oral drug therapy. It will require coordination efforts with providers, patients and care givers for solutions to ensure treatment benefits. This critical role requires a seasoned professional with leadership experience in new product launch and building new benefit services programs within the Bio/Pharma industry. The candidate will lead the strategic design, implementation and operations for the company’s patient reimbursement services programs and report to Vice President Market Access.
Major responsibilities will include:
- Responsibilities include but are not limited to Patient Reimbursement HUB, Financial Support Programs, Case Management Support and related patient support programs.
- The role functions as a subject matter expert on patient reimbursement support services and collaborates cross functionally within the commercial organization to design and implement programs that support the company’s patient access objectives.
- Maintains program SOPs, exceptions processes, workflows, scripting, training and report.
- Supports Field Payer Team reimbursement needs with strong communication and timely customer service to address customer needs.
- Leads the design, implementation and ongoing management of all patient reimbursement HUB services programs.
- Develops performance dashboards and interprets hub data for purposes of assessing market access trends, hub program utilization.
- Develops and maintains SOPs and business rules related to all US patient support.
- Provides strategic insights into Marketing to develop compliant content for the company’s US reimbursement support website. Drives material through marketing review process as required.
- Demonstrates fiscal discipline and accountability to effectively and efficiently manage external partners and vendors performance through appropriate metrics.
We seek candidates with the following qualifications:
- Bachelor’s degree required. MBA preferred.
- Requires 10+ years of experience within the biotech/specialty pharmaceutical/pharmaceutical industry.
- At least 3+ years of proven experience working with Patient Access call center HUB operations.
- Excellent analytical (qualitative and quantitative), strategic thinking, creativity and problem solving skills.
- In depth knowledge of pharmaceutical manufacturer compliance requirements, patient confidentiality (HIPAA regulations), product reimbursement and product access.
- Knowledge and experience in Medicare, Medicaid, and private payer policies, reimbursement process, health policy, areas of coverage, payment, coding, Specialty Pharmacy.
- Experience with Commercial Brand Planning process, able to translate brand disease state and business drivers into patient support programs and operational requirements.
- “Patient First” customer service orientation. Puts the patient at the center of all business activities.