Associate Director, Market Access and Payer Relationships (Eastern Zone)
Location:
,
Posted:
February 03, 2017
Reference:
00001HDC
Must have a strong commercial payer network. This is a remote position with frequent travel within the Eastern Time Zone Boundary.


POSITION SUMMARY:

The preferred candidate comes with a successful track record in payer account management in the field. Commercial Medicare, and Medicaid reimbursement product experience is required; The candidate should have a strong understanding of national commercial payers, top 10-20 regional commercial payers, PBM's, SPP's, recent national healthcare reform as well as federal, state and 3rd party payer systems; this includes working knowledge of FSS, PHS, Medicaid, VA ASP pricing requirements; thorough understanding of payer policy development with both public and commercial payers; working knowledge of reimbursement systems and processes for coverage with public and commercial payers; can set strategic and daily priorities; can develop and lead the implementation of influence plans thru multiple parties; has negotiated and implemented contracts; has strong verbal and written communication skills; is a team player; and produces results.

Additionally, the preferred candidate has a proven track record of success working with integrated delivery networks, hospital pharmacy, and administration to gain access to therapies administered in the inpatient and outpatient hospital settings; has a strong understanding of inpatient DRG reimbursement, admission and discharge processes; hospital economic rationale.

PRIMARY DUTIES AND RESPONSIBILITIES:


Support development and execution of client market access strategy for initial drug launch and/or new indication and collaborate in building associated team:
  • Set strategic priorities from a market access standpoint pertaining to client's drug/product
  • Segment payer market and advise commercialization group on approaches to pricing and reimbursement
  • Coordinate with commercial team to conduct relevant pricing research, integrating clinical, market, and payer information, to determine optimal price attainable within context of product's value proposition to providers, payers, and patients
  • Together with commercial group heads, develop annual pricing plan, taking into account the competitive landscape and likely effects of price adjustments on payer management, provider utilization, and patient access across the portfolio of products
  • Collaborate with necessary support team, including MSL/HEOR and sales functions
  • Coordinate market access strategy with distribution / supply chain function
Drive pricing and reimbursement discussions with payer community:
  • Conduct relevant reimbursement research (including coding, coverage, and payment) to develop strategic objectives for appropriate access among commercial and government payers
  • Develop reimbursement strategy to achieve commercial targets
  • Lead discussions and facilitate ongoing communication with relevant payers
Provider and Field Support:
  • Manage relationships and contracting for commercial payers and Medicare fiscal intermediaries
  • Develop and launch reimbursement HUBs to support products
  • Provide content expertise to marketing and commercial team in developing provider-targeted reimbursement tactics for use by sales representatives;
  • Create material for field training and continually update reimbursement material
Other critical tasks:

  • Provide input and guidance to the organization on pricing and reimbursement of developmental compounds
  • Anticipate, identify, and analyze changes in the pricing and reimbursement environment, gauge impact on clients pipeline, and communicate to internal stakeholders


    Qualifications:
    QUALIFICATIONS



    The ideal candidate for this role will have an experience base consisting of:

    • 5-10 years with a leading pharmaceutical company or innovative biotech in several of the following functional areas: payer account management, HEOR, pricing, reimbursement, new product development and market access strategy
    • Pricing & reimbursement (coverage, coding and payment) strategy and implementation
    • Developing value models and interpretation of HEOR data
    • Negotiating with both private/commercial payers, Medicare and Medicaid
    • Building a market access/managed markets team, consisting of HEOR, account management and other relevant functions
    • Familiarity with specialty distribution models and buy-and-bill channels
    • Familiarity with international markets
    Required experience includes:

    • Team leadership and functional management
    • Overseeing market access for a new product launch within the last 5 years
    • Account management and payer negotiation
    MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS:


    Knowledge of private payer, Medicare and Medicaid structure, systems, and reimbursement process
    Undergraduate degree required; MBA or other advanced degree preferred
    • Strong understanding of commercial payers, CMS, Medicare, and legislative/policy issues related to pricing and reimbursement of company products
    • Deep knowledge of reimbursement of pharmacy and medical benefit products in all settings of care
    • Knowledge of legal and compliance issues around pharmaceutical pricing and reimbursement
    • Understanding of health outcomes, economic and other value as drivers of optimal price
    • Experience in planning, pricing and sequencing for new product launch
    • Understanding of pharmaceutical distribution and supply chain
    • Strong MS Excel skills including experience in developing financial models and the ability to succinctly and clearly communicate recommended modeling to the leadership team
    • Public speaking and presentation experience preferred
    • Above average communication skills
    • Project management skills
    • Demonstrated teamwork abilities
    • Understanding and comfortable with escalating issues to direct manager in a timely manner
    • Ability to work independently
    • Ability to travel weekly three to four nights per week
    • Good driving record
    • Ability to drive at night
    • Ability to utilize own car for travel (mileage reimbursed)
    • Ability to schedule individual work related travel(air, hotel, rental car as needed)
    • Live within 45 minute drive of a major airport
    • Ability to manage expenses within allocated budgets
    • Above average computer skills: MS PowerPoint, MS Excel, MSWord and MS Outlook
    • Specific knowledge of local payer policies related to a specific client product will be acquired during training sessions.
    All interactions with allied health professionals require detailed attention to customer needs and satisfaction. And most importantly, all reimbursement activities are required to be conducted and managed within all appropriate legal and regulatory guidelines and require continuous monitoring of compliance with such guidelines and laws.

    This position may require credentialing for specific facilities. This process includes passing limited medical examinations and may include some vaccinations and documentation review.

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