Overview
Access and Reimbursement Manager (ARM) is a field-based role that proactively provides in-person (or virtual as needed) education to defined accounts within their assigned geographies on a wide range of access and reimbursement topics and needs in support of aligned product strategy. The ARM serves as the key contact and lead for access and reimbursement support-related matters and is responsible for being 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 a range of account workflows. The ARM demonstrates problem solving, analyzes access and reimbursement issues and opportunities, and proactively communicates changes in the healthcare landscape. This role partners closely with NPC field associates (Customer Engagement, Market Access) and coordinates cross-functionally within NPC (e.g., Patient Support Center, Marketing, State & Government Affairs, Trade, Specialty Pharmacy Account Management, and other applicable third-party affiliates). This is a remote and field-based role covering San Jose, CA, Fresno CA, East Bay, Walnut Creek CA. Associate must reside within the territory or within a reasonable daily commuting distance of 60 miles from the territory border.
Major Accountabilities
- Interact within assigned accounts to support patient access within their therapeutic area product(s) by providing proactive face-to-face education on product-specific programs to providers and staff to support integration of those programs into office processes and workflows.
- Address customer questions related to NPC policies on product ordering, payment, inventory, and product returns and replacement in offices.
- Work with key members of therapeutic area offices (providers, administrators, billing and coding staff, claims departments, revenue cycle managers) to appropriately support patient access to products.
- Analyze problems and offer solutions. Understand specifics and support questions related to payer policies (utilization management, denial, appeals), drug acquisition and inventory management, and patient/practice reimbursement (co-pay, administration, drug claims). Identify reimbursement trends and opportunities and partner internally and externally to support patient pull-through.
- Support pull-through on local coverage decisions to enable meaningful patient access; proactively communicate policy changes or issues that could affect other departments.
- Stand up NVS-sponsored patient support programs to enable patients starting and staying on therapy (e.g., Co-pay).
- Maintain expertise in regional/local access landscape and act as the aligned therapeutic area product reimbursement expert as needed.
- Interface with Patient Support Center on patient case management, tracking cases, issue resolution, reimbursement support, and education of appropriate office staff; review patient-specific information when requested and available.
- Collaborate with cross-functional NPC associates to share insights on customer needs and barriers for their aligned therapeutic area product(s) related to access and reimbursement.
- Maintain knowledge of NPC policies and requirements and perform responsibilities with integrity and in line with company guidance and values; handle Patient Identifiable Information in compliance with HIPAA and internal guidelines.
- Identify and report adverse events via established Novartis systems per applicable processes.
Buy and Bill Specific
- Assess access situation within the assigned geography and develop an appropriate Plan of Action (POA); communicate POA to the relevant personnel.
- Establish preferred acquisition pathways; educate on and support buy-and-bill end-to-end processes, workflows, and facility pull-through in complex accounts, including centralized and decentralized acquisition and alternative channels (white bagging, clear bagging, brown bagging, and alternate sites of care for administration).
- Educate stakeholders on logistics related to ordering, payment, inventory, and product returns and replacement.
- Analyze reimbursement issues and opportunities, acting as the designated reimbursement expert for offices and field teams.
- Engage with non-prescribers (pharmacy, system leadership, financial counselors, office admins, revenue cycle managers, etc.).
Key Performance Indicators
- Meet and exceed designated corporate objectives.
- Improve overall customer satisfaction and awareness related to Novartis programs and access support; enable customers to attain access to prescribed medicine (measured via start forms and hub metrics).
- Adhere to NPC policies, laws and regulations.
Education and ExperienceMinimum Requirements
Bachelor's Degree required. Advanced degree preferred.
- Three to five years of experience in public or private third-party reimbursement, pharmaceutical industry in managed care, clinical support, or sales.
- Experience with specialty pharmacy products through Specialty Pharmacy networks or specialty distributors (buy and bill).
- Experience with coding, billing and in-office support programs.
- Prior account management experience or experience with complex accounts (payer landscape, high patient volume, large systems).
- Specialty pharmacy experience required (ability to teach an office the entire process from script to injection).
- Establishing relationships within a practice to help remove reimbursement barriers to specialty products for patients.
- Knowledge of CMS policies and processes with expertise in Medicare Parts B and D is a plus.
- Knowledge of managed care, government and federal payer sectors, and IDN/Integrated Health Systems is a plus.
- Team player with ability to collaborate across sales and internal colleagues to reach goals.
- Ability to travel; 50%+ travel depending on territory.
- Must live within assigned territory and hold a valid driver's license; driving is an essential function.
- Accommodations for medical restrictions will be provided if it does not eliminate essential driving function.
- Strong knowledge of buy-and-bill reimbursement pathway and experience with injection networks.
Preferred Qualifications
- Ability to manage multiple products
- Excellent presentation skills
- Advanced knowledge of medical insurance terminology
- Strong teamwork abilities
- Project management skills
- Ability to work independently
- Ability to manage expenses within budgets
- Good driving record
- Ability to schedule travel (air, hotel, rental car)
- Proficient in PowerPoint, Excel, Word, CRM (Salesforce)
- Understanding of patient privacy laws including HIPAA
Compensation and Additional Details
The pay range for this position at commencement of employment is expected to be between $138,600 and $257,400 per year. Salary ranges may adjust during 2025. Final pay depends on location, experience, knowledge, skills, and abilities. The total compensation package may include a sign-on bonus, RSUs, discretionary awards, and a full range of benefits (401(k), PTO, etc.). At-will employment applies, with potential changes to base salary or other compensation programs over time.
The individual will be required to complete initial training (home study and on-site) in eight hours per day and forty hours per week or fewer.
Why Novartis
We're committed to helping people with disease and their families through a collaborative, supportive culture that drives breakthroughs. Learn more at Novartis People and Culture.
EEO Statement
The Novartis Group of Companies are Equal Opportunity Employers. We do not discriminate in recruitment, hiring, training, promotion or other employment practices for reasons of race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, marital or veteran status, disability, or any other legally protected status.
Accessibility & Reasonable Accommodations
The Novartis Group of Companies are committed to providing reasonable accommodations. For accommodation requests during the application process or to perform essential job functions, email or call the provided contact and include the job requisition number.
#J-18808-Ljbffr