Associate Director, Access & Reimbursement (ADAR) at Hire Well Screening Solutions LLC

Position Summary: 

• ADARs primarily focus on accounts with increased process and workflow complexity, typically including centralized and decentralized systems of care, integrated delivery networks, academic medical institutions, large multi-provider specialty practices, and alternate sites of care.

• ADARs will serve as the access and reimbursement lead in business-to-business conversations with account executives. The ADAR role is responsible for managing the pull-through of access and reimbursement strategy and downstream operations within their aligned accounts. ADARs are expected to have deep expertise in communicating requirements and addressing barriers associated with local payer policy coverage, multi-channel acquisition pathways, billing and coding (as needed), claims processing, reimbursement, and integration of manufacturer support programs into a range of account workflows. ADAR will continually need to demonstrate a keen ability to problem solve and manage multiple projects.

• ADARs partner closely with other field associates, including Customer Engagement (Sales) and Market Access, representing with the highest integrity in accordance with Values and Behaviors. ADARs will also be required to coordinate and communicate cross-functionally (e.g., Patient Support Center, Customer Engagement, Marketing, Market

• Access, Public Affairs, State & Government Affairs, Trade, Specialty Pharmacy Account Management, and other applicable third-party affiliates). 

Responsibilities:

• Interact with large, complex accounts to support patient access within their aligned therapeutic area product(s), and proactively provide face-to-face education on programs to providers and staff in order to support the integration of those products into office processes and workflows.

• Address customer questions for issues related to policies on therapeutic area product ordering, payment, inventorying, and product returns & replacement in offices.

• Work with key members of therapeutic area offices (e.g., executives, 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 patient reimbursement and coordinate reimbursement issues with third-party payers at the provider level.

• Analyze account reimbursement issues & amp; opportunities (as needed). Identifies trends at a local, regional, and national level and partners 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 informing customers on sponsored patient support programs to enable patients to start and stay on therapy (i.e., Co-pay).

• Maintain expertise in regional and local access landscape, anticipate changes in the healthcare landscape, and act as their aligned therapeutic area product(s) reimbursement expert (as needed).

• Collaborate with aligned cross-functional associates to share insights on customer needs and barriers for their aligned therapeutic area product(s) related to access and reimbursement;

• Interface with Patient Support Center (hub) and Access & Reimbursement Managers on important matters related to patient case management, including tracking cases, issue resolution, reimbursement support, and appropriate office staff education.

• Maintain a deep understanding of 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).

Buy and Bill Specific

• Assess the access situation within the assigned geography and develop an 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 decentralized acquisition, and use of alternative channels such as white bagging, clear bagging, brown bagging, and alternate site of care for administration.

• Educates relevant stakeholders on logistics related to ordering, payment, inventory, and product returns & replacement.

• Analyze reimbursement issues & opportunities, anticipate changes in the healthcare landscape, and act as the designated reimbursement expert for offices and field teams.

• Accountable for engagement with non-prescribers, for example, pharmacy, system leadership, financial counselors, office administrators, revenue cycle managers, etc. Radioligand Therapies Specific

• The ADAR will be a critical partner to the customer engagement team on supply

• capacity, site procurement eligibility, as well as a customer-facing resource for communications on orders and logistics.

• Understand RLT key priorities in core disease areas, financial goals, and site initiatives to influence overall account and regional business strategies.

• Assess and understand the site and/or other appropriate organizations’ level of readiness for procurement of nuclear medicines and billing to facilitate orders for products so that they can engage and educate on procurement systems and processes, access, and reimbursement. Be able to understand where gaps in procurement exist and work with Cross-Functional partners to resolve them.

• Partner with the customer engagement teams to assist in the communication and facilitation of procurement and logistics with both the site and the local field teams. (e.g., procurement, logistics processes, and timing) as well as patient-specific support (benefit verification, PA appeals and copay programs)

• Major accountabilities apply to therapy, diagnostic, and theragnostic treatment centers.

Essential Requirements:

• Education: Bachelor’s degree required; Business and/or biological science education preferred. Advanced degree preferred.

• 5+ Years of experience in the pharmaceuticals/biotech industry focused on Patient Services, Market Access, Sales, and/or account management, with 2 of those years being in a Patient Services practice support role for a specialty product(s).

• Experience working with highly complex practices and/or health systems to establish access and acquisition pathways.

• Strategic account management experience using a proactive approach to anticipate access hurdles impacting accounts and patient access.

• Deep expertise and experience integrating manufacturer-sponsored patient support programs.

• Experience with specialty products acquired through Specialty Pharmacy networks.

• Knowledge of reimbursement pathways (specialty pharmacy, buy-and-bill, retail)

• Possess a strong understanding of Commercial payers, Medicare plans, and state Medicaid in geographic regions.

• Must live within assigned territory; Ability to travel and cover geography, at least 50% travel required, based on geography and territory/targeting makeup.

Desirable Requirements:

• Experience leading and delivering presentations to C-level account executives.

• Strong ability to work cross-functionally with such functions as Field Sales, Marketing, Market Access, Public

• Affairs, State & Government Affairs, Trade, Specialty Pharmacy Account Management, and applicable third-party affiliates.

• Expertise in therapeutic area practice dynamics and common reimbursement and product program support-related needs. Such as Oncology, Prostate Cancer or Nuclear Medicines

• Strong capabilities in the areas of customer focus, collaboration, business acumen, communication, and presentation skills.

Benefits:

• 20% bonus

• LTI (Long-term incentive) 

• 3 weeks vacation

• 5 days PTO and (more will be discussed at the time of hire)