Regional Access & Reimbursement Associate Director
Scorpion Therapeutics, Topeka, KS, United States
Role Summary
The Regional Access and Reimbursement Associate Director will help ensure appropriate access and reimbursement of Vertex cellular and genetic therapies through education within an assigned geography in close collaboration with US Market Access functions, US Public Affairs, Field Health Economics Outcomes Research, Patient Support, Account Management/Sales and Marketing colleagues. The role will proactively build customer relationships within a geography to help ensure patient access to therapies and resolution of potential customer reimbursement challenges, and will serve as the state/regional expert on reimbursement (coding, coverage, payment). This role develops and maintains in-depth regional/account business plans and provides timely insights on coding, payer coverage policy developments, reimbursement, contracting trends, and competitive activity. This position reports to the National Director of Access and Reimbursement. Location: Field Based, Southern and Southeast States.
Responsibilities
Appropriately partners with internal stakeholders across functions (Payer Accounts, State Government Affairs, Trade and Distribution, Hospital Account Managers, Marketing, Patient Support) to develop and achieve targeted plans of action.
Effectively manages objectives and priorities across multiple therapeutic areas.
Collaborates closely with field payer teams on coverage policy developments and coding education.
Develops and geographic and account business plans.
Establishes relationships with key institution/hospital personnel: C‑Suite, Operations, Revenue Cycle Management, Finance, Managed Care, and other stakeholders responsible for access, coding, billing, reimbursement and overall financial clearance.
Provides reimbursement‑related support and education (Hospital Economics, Coding, Billing, Payment, Policy, Processes) to secure access for new procedures and therapies.
Coordinates comprehensive reimbursement pull‑through by proactively engaging with institution/hospital personnel to educate on:
Managed care and government payer coverage policies
Billing and coding requirements
Medicare and State Medicaid reimbursement methodologies
Prior Authorization and medical exception processes
Claims submission and appeals processes
Trade and Distribution
Ensures appropriate adoption and implementation of newly issued codes.
Tracks all local payer billing, coding, and claims submission requirements.
Leads cross‑functional challenge resolution processes including interfacing with Patient Support as appropriate.
Qualifications
Required: Bachelor's degree in relevant field; typically 8 or more years of experience or the equivalent
Preferred: Master’s/Advanced degree
Preferred: Current experience in cell and gene therapy access and reimbursement
Preferred: Demonstrated experience in a field reimbursement or hospital administration role with demonstrated ability to problem solve reimbursement challenges within Hospital/Institution inpatient setting
Skills
Ability to perform in a fast‑paced environment, manage multiple priorities simultaneously, and work effectively across functional teams
Excellent analytical, strategic thinking and communication skills
Expertise in the US market access environment across Commercial Payers, managed and fee‑for‑service segments of Medicaid/Medicare, Hospitals/health systems, benefit designs, coverage policies and reimbursement methodologies
Expertise in the institution/hospital inpatient setting related to access and reimbursement requirements by department and overall hospital economics
Expertise in hospital financial and operational processes
Education
Bachelor’s degree in relevant field required
Master’s/Advanced degree preferred
Additional Requirements
Travel: Overnight and weekend travel to attend internal meetings and conferences, and to operate within the required geography (at least 80% of travel within the assigned geography)
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Responsibilities
Appropriately partners with internal stakeholders across functions (Payer Accounts, State Government Affairs, Trade and Distribution, Hospital Account Managers, Marketing, Patient Support) to develop and achieve targeted plans of action.
Effectively manages objectives and priorities across multiple therapeutic areas.
Collaborates closely with field payer teams on coverage policy developments and coding education.
Develops and geographic and account business plans.
Establishes relationships with key institution/hospital personnel: C‑Suite, Operations, Revenue Cycle Management, Finance, Managed Care, and other stakeholders responsible for access, coding, billing, reimbursement and overall financial clearance.
Provides reimbursement‑related support and education (Hospital Economics, Coding, Billing, Payment, Policy, Processes) to secure access for new procedures and therapies.
Coordinates comprehensive reimbursement pull‑through by proactively engaging with institution/hospital personnel to educate on:
Managed care and government payer coverage policies
Billing and coding requirements
Medicare and State Medicaid reimbursement methodologies
Prior Authorization and medical exception processes
Claims submission and appeals processes
Trade and Distribution
Ensures appropriate adoption and implementation of newly issued codes.
Tracks all local payer billing, coding, and claims submission requirements.
Leads cross‑functional challenge resolution processes including interfacing with Patient Support as appropriate.
Qualifications
Required: Bachelor's degree in relevant field; typically 8 or more years of experience or the equivalent
Preferred: Master’s/Advanced degree
Preferred: Current experience in cell and gene therapy access and reimbursement
Preferred: Demonstrated experience in a field reimbursement or hospital administration role with demonstrated ability to problem solve reimbursement challenges within Hospital/Institution inpatient setting
Skills
Ability to perform in a fast‑paced environment, manage multiple priorities simultaneously, and work effectively across functional teams
Excellent analytical, strategic thinking and communication skills
Expertise in the US market access environment across Commercial Payers, managed and fee‑for‑service segments of Medicaid/Medicare, Hospitals/health systems, benefit designs, coverage policies and reimbursement methodologies
Expertise in the institution/hospital inpatient setting related to access and reimbursement requirements by department and overall hospital economics
Expertise in hospital financial and operational processes
Education
Bachelor’s degree in relevant field required
Master’s/Advanced degree preferred
Additional Requirements
Travel: Overnight and weekend travel to attend internal meetings and conferences, and to operate within the required geography (at least 80% of travel within the assigned geography)
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