Primary Purpose of Position
The Director, Reimbursement Services is the primary leader of reimbursement efforts for patients referred into thereimbursement support process and is responsible for monitoring and reporting on key performance metrics for reimbursement.
This position acts as the primary liaison between the sales force, the hotline, and the Regional Access Manager team and works directly with the brand team to support critical success factors, recommending any improvements or changes necessary to react to marketplace dynamics.
The Director is also responsible for reporting on key metrics as needed for special initiatives. Strong analytical and presentation skills are required.
The specific duties and responsibilities for this position include, but are not limited to, the following:
- Day to day oversight and management of the hotline services program
- Ensure that medical necessity support, including appeal assistance, is effectively deployed in order to support a positive determination, when possible.
- Leverage clinical insights to review and provide guidance to providers on Insurance Verification Requests (IVRs) in orderto improve positive determinations.
- Manage new IVRs through the reimbursement evaluation process at the hotline, ensuring optimal speed to coverage determination.
- Direct field reimbursement consultants, as needed, to train and inform provider offices of insurance authorizations or appeals.
- Triage any payor obstacles to the Market Access team for further research and/or management.
- Hire and train internal RLAs as needed to support reimbursement and hotline.
- Lead monthly conference calls with the commercial leadership team to review performance metrics, new and open reimbursement cases and other critical performance requirements.
- Recommend improvements and process changes to hotline services as necessary, within the scope of company compliance guidelines, to support patient and provider needs.
- Report weekly and/or as needed on IVRs, PA, medical necessity and other KPIs.
- Monitor and assess performance measures including IVR turnaround time (ITT), account documentation and the qualityof provider submissions.
- Lead Quarterly Business Reviews with the Market Access team.
- Escalate customer service and data delivery with the hotline systems, as needed, and monitor resolution of those issues.
- Oversee ASP submission process with Finance and ensure updates are properly communicated to service providers.
- BA/BS degree required. Medical degree preferred – RN or similar. MBA or advanced degree in a related field preferred
- 5+ years previous pharmaceutical/biotech experience, tissue experience a plus
- 2+ years experience working with a reimbursement services hotline
- Experience leading teams and managing people
- Experience working with multiple projects and managing multiple external partners
- Extensive knowledge of reimbursement and managed care landscape, reimbursement processes, and hotline operations
- Strong analytical, planning, project management, communication, and organization skills
- Flexibility to work in a fluid, fast-paced environment and respond quickly to new deadlines
- Strong initiative and independence
- Team orientation a must
- Strong Microsoft Excel and PowerPoint skills required
- HQ (Columbia, MD) based position
- Travel (15%)
Job ID 2017-1215