Shire Reimbursement and Access Manager - California in United States

Reimbursement and Access Manager - Patient Services; Field Based

Responsibilities:

The Reimbursement and Access Manager (RAM) is a regional, field-based position that provides logistical reimbursement education and support for customers that directly purchase immunology and hematology products from Shire. These customers may include hospitals/hospital outpatient departments, physician practices, and other appropriate site-of-care facilities as well as specialty pharmacies. The RAM will work closely with HCPs, pharmacists, billing and coding staff and other professionals involved in securing appropriate reimbursement for the use of Shire products. If necessary, the RAM will interact with patients being served by these customers, to assist providers as well as patients addressing barriers to appropriate access.

Essential responsibilities of the RAM include:

  • Provide CMLR- approved information related to product coverage and reimbursement to appropriate clinic, hospital and other site-of-care facilities. This information may include payer specific requirements for claims processing, information regarding prior authorizations and the appeals process, as well as general information regarding disease state.

  • Proactively educate prescriber office personnel so that they may help patients gain access to our products through effective utilization of Shire patient services. Educate on coding of Shire products (CPT, ICD9-ICD10, HCPCS), including specific instruction on billing for new drugs/biologics described by a miscellaneous J code, using CMLR-approved materials.

  • Deliver in-service educational programs on coverage, coding and reimbursement across appropriate providers on all Shire-manufactured products.

  • Reactively address access and reimbursement issues arising from these customers, and provide necessary education for them to secure appropriate reimbursement and access. Interact with healthcare professionals, as well as patients if necessary, to understand the issue and work toward resolution. Maintain communication with sales personnel throughout interaction, and follow interaction through to resolution.

  • Interact with MAC’s as needed for issue resolution, following Patient Services outlined escalation process.

  • Provide healthcare professionals with CMLR- approved support materials and sample forms and letters to assist in obtaining reimbursement of Shire products. This includes, for example, a sample CMS 1500 Billing Form template.

  • Coordinate with field sales regarding prioritization of accounts to ensure timely access to Shire products. Ensure ongoing communication with field sales regarding account follow-up plan.

  • Serve as a primary point of contact for Market Access team for distribution and payer issues.

  • Serve as an escalation point for the hub to educate customers on appropriate available patient support programs. Explain the co-pay assistance and other funding options available to patients for Shire products. Provide CMLR-approved materials describing such programs and refer to the applicable Shire website(s) describing such programs. Help a practice understand how to enroll patients in the appropriate program. Advocate for Shire hub service utilization for patient-specific access support needs.

Education and Experience Requirements:

  • Minimum of Bachelor’s Degree required

  • Minimum of 3 years of prior field-based reimbursement and access experience required

  • Minimum of 3 years of other related pharmaceutical experience strongly preferred (e.g., Market Access, Sales, Product Marketing)

Key Skills, Abilities and Competencies:

  • Demonstrated high performance in a reimbursement/access support role

  • Experience in a field-based customer support role

  • Expert-level understanding of local, regional and national commercial and public insurance markets

  • Strong understanding of specialty pharmacy operations and specialty product distribution channels

  • Ability to work cross-functionally and succeed in a team environment while also demonstrating a high-level of personal accountability

  • Strong interpersonal and communication skills

  • Ability to travel (up to 80%)

Complexity and Problem Solving:

  • Knowledge of relevant medical and pharmaceutical payer coverage policies. Ability to continually monitor policies and effectively communicate changes

  • Ability to proactively plan and closely coordinate account interactions in conjunction with other field-based teams

  • Ability to balance proactive education and reactive problem solving to address critical customer issues that arise

Internal and External Contacts:

External: HCPs, pharmacy, and billing/coding staff associated with key institutional customers, as well as patients being treated in these institutions

  • Academic centers, community hospital, HTC, infusion centers

  • Consortium members, and buy and bill MD offices

  • Specialty Pharmacies

  • Medicare Administrative Contractors Internal: Market Access, Advocacy, Field Sales, other Patient Services teams (including outsourced hub services) Other Job Requirements: Position requires extensive domestic travel (up to 80%)

Notice to Employment / Recruitment Agents:

Employment / Recruitment agents may only submit candidates for vacancies only if they have written authorization to do so from Shire’s Talent Acquisition department. Any agency candidate submission may only be submitted to positions opened to the agency through the specific Agency Portal. Shire will only pay a fee for candidates submitted or presented where there is a fully executed contract in place between the Employment / Recruitment agents and Shire and only if the candidate is submitted via the Agency Portal. Candidates submitted or presented by Employment / Recruitment Agents without a fully executed contract or submitted through this site shall not be deemed to form part of any Engagement for which the Agency may claim remuneration.

Equal Employment Opportunity

Shire is an Equal Opportunity Employer committed to a diverse workforce. Shire will not discriminate against any worker or job applicant on the basis of race, color, religion, gender, gender identity, national origin, ancestry, age, sexual orientation, marital or civil partnership status, pregnancy, gender reassignment, non-job related mental or physical disability, genetic information, veteran status, military service, application for military service, or membership in any other category protected under law.

EEO is the Law - https://www.dol.gov/ofccp/regs/compliance/posters/pdf/eeopost.pdf

EEO is the Law – Supplement - https://www.dol.gov/ofccp/regs/compliance/posters/pdf/OFCCPEEOSupplementFinalJRFQA508c.pdf

Pay Transparency Policy - https://www.dol.gov/ofccp/pdf/pay-transp_formattedESQA508c.pdf

Reasonable Accommodations

Shire is committed to working with and providing reasonable accommodation to individuals with disabilities. If, because of a medical condition or disability, you need a reasonable accommodation for any part of the application process, or in order to perform the essential functions of a position, please call 484-595-8400 and let us know the nature of your request and your contact information.

Shire is the leading global biotechnology company focused on serving people with rare diseases and other highly specialized conditions. We strive to develop best-in-class products, many of which are available in more than 100 countries, across core therapeutic areas including Hematology, Immunology, Neuroscience, Ophthalmics, Lysosomal Storage Disorders, Gastrointestinal/Internal Medicine/Endocrine and Hereditary Angioedema; and a growing franchise in Oncology.

Our employees come to work every day with a shared mission: to develop and deliver breakthrough therapies for the hundreds of millions of people in the world affected by rare diseases and other high-need conditions, and who lack effective therapies to live their lives to the fullest.