Market Access Field Reimbursement Manager
ADMA BIOMANUFACTURING LLC
Location
Boca Raton, FL | United States
Job description
Job Details
Level Management
Job Location ADMA Biologics - Boca Raton, FL
Remote Type Fully Remote
Position Type Full Time
Job Shift Day
Description ADMA Biologics is a biopharmaceutical company relentlessly committed to creating superior products for immunodeficient patients at risk for infection. It is our devotion to this underserved population that fuels us and our hands-on approach to production and development that sets us apart. If you are looking for a dynamic, innovative, growing company in the biopharmaceutical industry that is committed to excellence and integrity, then consider ADMA Biologics. We currently have an exciting opportunity available for a
Manager of Market Access, Reimbursement & National Accounts - Western Region! The
Market Access Field Reimbursement Manager (FRM) - Western Region will proactively engage with the ADMA field force to provide education and support to providers and their offices/staff on ADMA HUB Patient Support Program and services, current national and regional payor coverage, and payor policy for regionally and nationally based customers. This role serves as the key contact for field-based reimbursement and access support-related matters and is responsible for being the local market access expert on payer, policy, and processes to help partners navigate coverage and help support patients.
The (FRM) will work with the ADvantage Ig Patient Support Program (HUB) to help ensure clear and transparent communication between provider and ADMA in order to help support the entire reimbursement journey from patient start form submission through payer prior authorization to appeals/denials requirements procedures and forms. Working in conjunction with the HUB reviewing de-identified information in cases where the site of care has specifically requested the assistance in resolving any issues or coverage challenges.
The (FRM) will analyze reimbursement and access issues and serve as the local access and reimbursement resource for customer facing personnel. The (FRM) will communicate any issue's, needs or concerns to the management and collaborate cross-functionally in order to develop and institute a plan of action to address any field-based needs or concerns.
In addition, this individual will also be responsible for working with both internal and external ADMA team partners to develop, execute and measure activities to maximize pull through by coordinated business planning. Key account responsibilities can include, but are not limited to, National and Regional Infusion Providers and Specialty Pharmacies, Ambulatory Infusion Centers, Multi-Specialty Physician Owned Infusion Suites, GPO's, Transplant Centers, National and/or Regional Payers, Children's Hospitals, NCCN Cancer Centers.
Qualifications ESSENTIALS OF THE JOB: - Responsibilities to have a majority focus on payers, field reimbursement, and market access with past payer and field reimbursement experience necessary.
- Cultivate and establish essential relationships with payers and key field reimbursement personnel to forward the ADMA plasma portfolio.
- Support the development and execution of Site of Care (SOC) strategies that will help identify and expand access to ADMA's IVIG portfolio in a designated region.
- Will have a deep understanding of Payor policy and coverage as it pertains to infused products and SOCs.
- Support Sales team by engaging with appropriate stake holders to illustrate the value of ADMA's portfolio with SOC customers using appropriate tools and presentations.
- Responsible for partnering with sales to help develop and grow relationships with appropriate individuals within SOC to meet the business needs of the customer/partner and ADMA Biologics through a collaborative approach while driving results.
- The Manager will work cross functionally with (Medical, Marketing, Legal, Compliance, etc.) to develop approved SOC tools, resources, messaging, and programs designed to support sales teams and achieve short-term and long-term business objectives.
- Identify and address product barriers to SOC access, acquisition cost, payor coverage, and reimbursement concerns, by applying advanced understanding and application of analytics.
- Based on business demands, lead key projects and initiatives that require significant cross functional responsibilities and guide the resolution of complex business problems through innovation and proactive stakeholder engagement.
- Work closely with other ADMA Biologics teams to gather and analyze clinical, economic and reimbursement information from multiple sources to develop a full knowledge base regarding key customers.
- Work with to help support the formulary approval process and pull through.
- Lead customer engagements regarding the economic impact of ADMA Biologics solutions pre and post post-formulary approval, including preparation of budget impact analyses.
- Working with sales leadership to develop and execute integrated business plans to increase and maximize compliant Site of Care options.
- Maximize site of care (SOC) opportunities in accordance with product labeling, strategic imperatives, and company policies.
- Evaluate, develop, monitor, measure partnerships/business plans within the designated customer/partner accounts to align with defined objectives (profit, growth, value).
- Develop a strong alliance with field-based colleagues to ensure the appropriate level of cross-functional support for customers within a defined geography and for developing and executing pull-through strategies.
- Develop and deliver business presentations/reviews to customers/partners based on mutual needs/benefits.
- Identify national and regional specific opportunities and barriers to ensure corporate success.
- Review and analyze contracted performance and communicate account performance broadly with key internal stakeholders.
- The employee will be responsible for developing and implementing his/her own business plan.
- Work closely with broad range of stakeholders/customers ranging from individual physicians/providers within a hospital all the way up to C Suite at the System level to fully understand their business needs and perspectives.
- Leverages subject matter expertise in the areas of reimbursement, economics, and quality to demonstrate value to the customer and secure permission for deeper engagement.
Education Requirements: - Bachelor's degree required, preferably in life science or business, master's degree a plus. (RN is a plus)
Experience Requirements: - Direct experience working with and across the various infusion service areas within the US health care system specifically, national/regional service providers, hospital inpatient and outpatient infusion centers, home or in home infusion service providers, and individual buy and bill physician office practices.
- Must have 3 - 5 years' experience with payers, field reimbursement and market access.
- Must have a strong analytical background.
- Buy and bill experience and success strongly preferred.
- Biologic/biotech sales and reimbursement experience strongly preferred.
- Minimum of 6 years' experience with market access/site of care customer segments and reimbursement (commercial and government payers, billing/coding) with infused products required.
- Direct experience with identifying and activating sites of care in various infusion service areas such as:
- National and/or regional infusion service providers (i.e., SPs, Infusion Management Companies, etc.)
- Ambulatory Infusion Centers (AICs)
- Individual buy and bill physician office practices, i.e., Infectious Disease, Immunology, Oncology
- GPOs
- Ability to work independently and make decisions but with the knowledge of the situations where supervisory input is essential.
- Strong understanding of healthcare regulatory and enforcement environments along with demonstrated integrity on the job.
- Fosters innovation in account approaches and practices.
- Strong attention to detail, combined with a keen ability to recognize issues in the context of higher-level policies and regulations.
- Excellent planning and organizational skills to work within date-sensitive deadlines.
- Ability to work cross-functionally in a highly dynamic environment with a high sense of urgency.
- Ability to travel up to 75% of workdays.
- Proficient in Microsoft Office, Excel, and PowerPoint.
- Professional, initiative-taking, and collaborative demeanor.
- Strong people skills.
- Excellent written and verbal communication skills.
In addition to competitive compensation, we offer a comprehensive benefits package including: - 401K plan with employer match and immediate vesting
- Medical, Vision, Life and Dental Insurance
- Pet Insurance
- Company paid STD and LTD
- Company Paid Holidays
- 3 Weeks' Paid Time Off (within the first year)
- Tuition Assistance (after the first year)
- Easily accessible to Tri-Rail
- Free Shuttle to the Boca Tri-Rail station
ADMA Biologics uses E-Verify to confirm the employment eligibility of all newly hired employees. To learn more about E-Verify, including your rights and responsibilities, please visit
ADMA Biologics is an Equal Opportunity Employer.
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