Reimbursement Manager Jobs

INTRODUCTION

At Eisai, satisfying unmet medical needs and increasing the benefits healthcare provides to patients, their families, and caregivers is Eisai’s human health care (hhc) mission. We’re a growing pharmaceutical company that is breaking through in neurology and oncology, with a strong emphasis on research and development. Our history includes the development of many innovative medicines, notably the discovery of the world's most widely-used treatment for Alzheimer’s disease. As we continue to expand, we are seeking highly-motivated individuals who want to work in a fast-paced environment and make a difference. If this is your profile, we want to hear from you.

ROLE AND RESPONSIBILITIES

The Executive Portfolio Access and Reimbursement Manager (PARM) will provide support for patient access to prescribed Eisai products through communication and education with healthcare professionals and internal Eisai staff. The Portfolio Access and Reimbursement Manager (PARM) serves as primary point of contact for all Oncology Access and Reimbursement education and patient support in an assigned geography.

In addition, this role is the recognized subject matter expert and second level of support for complex access and reimbursement cases for both Oncology and Neurology. The PARM brings deep expertise in evaluating intricate payer issues and will be engaged when a higher level of strategic or technical insight is required to address access challenges. In the event of an access or reimbursement issue that cannot be resolved by the local Access and Reimbursement Manager, the PARM will use Eisai-approved resources to diagnose the root cause of the access challenge and appropriately engage internal Eisai Market Access stakeholders or external stakeholders to provide access options to care. The PARM must have a strong understanding of PHI, state privacy laws, and compliant engagement standards as outlined by Eisai. Additionally, this role will have a keen understanding of payer coverage at the customer and regional level and strong communication skills to appropriately educate on payer policies. The PARM will support the Oncology and Neurology business units, providing access and reimbursement education. The PARM will serve as the lead field trainer for ARMs in their region and mentor new hires to the Access and Reimbursement team. The PARM must possess knowledge of buy-and-bill, J-code billing, and specialty distribution, and must also possess a deep understanding of the complexities of the evolving healthcare landscape, including the Inflation Reduction Act, Medicare Part D redesign, copay maximizers and accumulators, alternate funding programs, and other market access dynamics. The PARM role will be a field-based individual contributor reporting into the Eisai Access and Reimbursement team under Patient Services/Market Access.

Working closely with, and reporting to, the Associate Director of Access & Reimbursement, the PARM will be responsible for providing education on access and reimbursement activities across HCP offices, alternate sites of infusion care, Medically Integrated Specialty Pharmacies, and health systems/institutions in both oncology and neurology. PARMs will interface with the following stakeholders, including, but not limited to: Health Care Professional, Practice Managers, Financial Counselors, Pharmacy Managers/Directors, Business Administrators, State Societies, C- and D-suite Health System personnel, and Revenue Cycle/Integrity professionals.

Essential Functions

• Consistently demonstrate uncompromised integrity while working cross-functionally and collaboratively with Eisai internal and external stakeholders. Strong understanding of legal and regulatory parameters related to HIPAA guidelines, state privacy laws, patient access and support program services. Comply with all Eisai promotional and administrative policies and applicable law.
• Communicate with providers to understand challenges in the patient access process and provide appropriate information to help support patient access to prescribed Eisai therapy.
• Serves as the second level point of contact for the Access and Reimbursement Managers for case escalations when payer delays, denials, or unclear information are relayed back to the healthcare provider, and there are no recognizable next steps for resolution.
• Engage with appropriate neurology and oncology accounts, providing them with access and reimbursement insight and/or education consistent with Eisai’s policies.
• Appropriately educate on Eisai patient support programs consistent with Eisai policies. This would include answering questions about Eisai Patient Support programs and distribution channels to procure Eisai product(s).
• Serve as the ARM Field Training Lead, periodically working with Access and Reimbursement Managers to communicate field insights to Access and Reimbursement leadership and senior leadership.
• Appropriately communicate with cross functional colleagues & departments to compliantly exchange information, understand, and share opportunities that could result in the development of solutions to patient access challenges for Eisai products.
• Mentor and train new hires to the Access and Reimbursement team.
• Travel overnight to assigned accounts, conduct field training visits, and attend relevant conferences, trainings, and company meetings.
• Through the access and reimbursement function, the PARM will support Eisai’s human health care mission.

Essential Traits for Success:

• Proven ability to lead without authority
• Patient Access-Focused
• Collaborative Problem Solver
• Priority Setting
• Results Oriented
• Strategic Agility
• Strategic Planning Acumen
• Operating within Ambiguity

BASIC QUALIFICATIONS

• BA/BS Degree required
• 7+ years of relevant pharmaceutical or biotech experience required.
• At least 4 years buy & bill experience with a medical benefit infused product is preferred
• Understanding of the various elements of Medicare and local MAC policy is preferred.
• Demonstrated understanding and experience across various payer segments (Commercial, Medicare, Medicaid and other Federal).
• Previous Oncology or Neurology experience is preferred.
• Strong understanding of medical and pharmacy benefit design, coverage policies and reimbursement methodology.
• Experience working with Patient Support Programs and other patient access and support programs.
• Ability to informally lead others without authority, exhibit a servant leader mentality.
• Must be able to organize, prioritize, and work effectively to meet deadlines within a constantly changing environment.
• Strong understanding of healthcare regulatory and enforcement environments along with demonstrated integrity on the job.
• Highly organized, strategic thinker with excellent written/verbal communication, and presentation skills.
• Demonstrates a high level of emotional intelligence and self-awareness, the ability to excel with multiple objectives simultaneously.
• Demonstrated ability to develop relationships with stakeholders and strong collaborator.
• Must successfully complete all company training programs and pass the company certification process, as well as all customer mandated and vendor credential requirements.
• Valid US driver’s license and a driving record in compliance with company standards.
• Must reside within the geography with the ability to travel to support needs to the business, percentage of overnight travel is dependent on geography.
• Ability to safely and successfully operate a motor vehicle is required.

As a condition of employment and an essential function of this field-based position, applicants must be able to engage in person with HCPs and other third parties at their offices, institutions and other appropriate locations on a regular basis. In order to gain in-person access, applicants selected for the position may be required to complete third parties’ credentialing and/or entry requirements, which often include an attestation to and/or providing proof of having received certain vaccinations. To the extent you are unable to meet certain requirements for qualifying medical (including pregnancy-related) or religious reasons, applicants must request a reasonable accommodation by contacting the Human Resources Department.

Eisai Salary Transparency Language:

The annual base salary range for the Executive, Portfolio Access and Reimbursement Manager (Mid-Atlantic) is from: $178,700-$234,600. Under current guidelines, this position is eligible to participate in: Eisai Inc. Annual Incentive Plan. Final pay determinations will depend on various factors including but not limited to experience level, education, knowledge, and skills.

Employees are eligible to participate in Company employee benefit programs. For additional information on Company employee benefits programs, visit https://careers.eisai.com/us/en/compensation-and-benefits.

Certain other benefits may be available for this position, please discuss any questions with your recruiter.

Eisai is an equal opportunity employer and as such, is committed in policy and in practice to recruit, hire, train, and promote in all job qualifications without regard to race, color, religion, gender, age, national origin, citizenship status, marital status, sexual orientation, gender identity, disability or veteran status. Similarly, considering the need for reasonable accommodations, Eisai prohibits discrimination against persons because of disability, including disabled veterans.

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