Assure Program Manager (Patient Support & Reimbursement) - Los Angeles North, CA

US-Remote
Requisition ID
2017-9995

Overview

Otsuka America Pharmaceutical, Inc. (OAPI) is an innovative, fast-growing healthcare company that commercializes Otsuka-discovered and in-licensed products in the U.S. With a strong focus on neuroscience, oncology, cardio-renal and medical device, OAPI is dedicated to improving patient health and the quality of human life. OAPI is part of the Otsuka Group companies. For more information, visit www.otsuka-us.com

Responsibilities

Position Summary:

The ASSURE Program Manager (APM) will provide field-based support and expertise to help resolve patient access issues, educate offices and hospitals on appropriate billing and coding for Otsuka products, and provide educational services within relevant sites of care. The APM will work directly with office support staff, hospital billing and coding staff, third party vendors (Helpline, Copay Card, Patient Assistance Program (PAP)), and other important stakeholders involved with supporting patient access to Otsuka therapies.

 


Key Responsibilities:

  • Manage daily activities that support appropriate patient access to Otsuka products across relevant sites of care and work as an extension of the patient assistance and reimbursement support services offered to patients and providers
  • Provide education to accounts to help facilitate patient access, such as reviewing coverage and access options across Otsuka’s product portfolio, outlining prior authorization requirements across relevant payers, and discussing alternate funding/financial assistance programs that may be available regionally for patients
  • Review appropriate billing and coding for products, assist with resolving reimbursement issues, and help ensure appropriate education to avoid future reimbursement hurdles
  • Educate office staff on the use of Otsuka’s patient assistance and reimbursement support services, including a web-based provider portal, enrollment forms, and templates
  • Present and educate sites on relevant reimbursement topics (ie, ICD-10, Healthcare Reform, Exchanges, ACOs, Discharge and the Importance of Continuity of Care, etc.)
  • Assist sites with understanding local payer coverage and reimbursement trends
  • Lead training related to product reimbursement for internal stakeholders, as appropriate
  • Communicate reimbursement concerns and issues with appropriate internal stakeholders
  • Work collaboratively with Market Access team to escalate potential payer issues
  • Conduct planning meetings with AMs to provide appropriate support
  • Act independently and to take initiative with minimal supervision from manager
  • Provide consultative reimbursement support to internal and external stakeholders
  • Able to troubleshoot reimbursement issues
  • Ability to diffuse situations within an office or hospital due to reimbursement concerns
  • Tailor approach and message to relevant stakeholders (ie, nurse vs HCP vs biller)

Qualifications

Experience:

  • Minimum of two years of experience in public or private third-party reimbursement; previous field reimbursement manager experience preferred
  • Must have worked with a pharmaceutical, biotech, or device manufacturer sales team in a reimbursement capacity or as a contract position through a reimbursement consulting agency
  • Must have specific practice management, billing and/or coding experience for drugs, biologicals, or devices under a “buy & bill” and specialty pharmacy model
  • Previous mental health experience preferred
  • Must be able to assist prescribers and their staff with addressing barriers to appropriate patient access to Otsuka’s products, which requires a broad knowledge of the claims revenue cycle process
  • Possess an understanding of reimbursement considerations from a patient and provider perspective, with an ability to effectively interact and navigate within various sites of care (i.e., physician office, CMHC, Mental Health Facility, pharmacy, hospital outpatient department etc.)
  • Must have general payer policy knowledge including public and private payers, foundational knowledge of benefit verifications and prior authorization requirements and knowledge of reimbursement processes across various sites of care
  • 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

Skills and Abilities:

  • Public speaking / presentations / education experience required
  • Demonstrated ability to conduct field-based reimbursement support and education
  • Experience with reimbursement billing, coding, and appeals process
  • Experience with new product launches, including billing with a miscellaneous HCPCS code, miscellaneous CPT code, and / or transition to billing with a unique HCPCS code
  • Knowledge of private payer, Medicare and Medicaid structure, systems, and reimbursement process
  • Ability to analyze and interpret regulation and legislation
  • Project management skills
  • Ability to work independently, manage travel schedules, schedule visits (territory management)
  • Ability to travel overnight
  • Strong computer skills (PowerPoint, Word, Excel)
  • The APM should have a travel expectation of 50-80%.
  • You may be required to provide hospitals proof of childhood immunizations, a negative TB test and other requirements, as set by the hospital protocol for access.

Education:

  • Bachelor’s degree required, advanced degree preferred.

 

Come discover more about Otsuka and our benefit offerings; click here for more information

 

Disclaimer:

This job description is intended to describe the general nature and level of the work being performed by the people assigned to this position. It is not intended to include every job duty and responsibility specific to the position. Otsuka reserves the right to amend and change responsibilities to meet business and organizational needs as necessary.

Otsuka is an equal opportunity employer. All qualified applicants are encouraged to apply and will receive consideration for employment without regard to their protected veteran or disabled status, or any protected status.

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