Regional Access & Reimbursement Associate Director
Scorpion Therapeutics, Frankfort, KY, United States
Role Summary
The Regional Access and Reimbursement Associate Director will drive access and reimbursement for Vertex cellular and genetic therapies within a defined geography by educating customers and collaborating with US Market Access, US Public Affairs, Field Health Economics Outcomes Research, Patient Support, Account Management, Sales and Marketing. The role serves as the state/regional expert on reimbursement (coding, coverage, payment), develops and maintains in-depth regional/account business plans, and provides timely insights on coding policy developments, payer coverage, 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 maintains 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.
Requires overnight and weekend travel to attend internal meetings, conferences and at least 80% within assigned geography.
Qualifications
Typically requires 8 or more years of experience or the equivalent combination of education and experience.
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.
Education
Bachelor’s degree in relevant field required; Master’s/Advanced degree preferred.
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 operating processes.
Additional Requirements
Requires overnight and weekend travel to attend internal meetings, conferences and at least 80% within assigned geography.
Maintains compliance with Vertex SOPs and guidelines.
#J-18808-Ljbffr
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 maintains 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.
Requires overnight and weekend travel to attend internal meetings, conferences and at least 80% within assigned geography.
Qualifications
Typically requires 8 or more years of experience or the equivalent combination of education and experience.
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.
Education
Bachelor’s degree in relevant field required; Master’s/Advanced degree preferred.
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 operating processes.
Additional Requirements
Requires overnight and weekend travel to attend internal meetings, conferences and at least 80% within assigned geography.
Maintains compliance with Vertex SOPs and guidelines.
#J-18808-Ljbffr