Reimbursement Specialist - Healthcare jobs in Somerset, NJ

About Pharming

Pharming Group N.V. (Nasdaq: PHAR/Euronext Amsterdam: PHARM) is a global biopharmaceutical company dedicated to transforming the lives of patients with rare, debilitating, and life-threatening diseases. Pharming is commercializing and developing an innovative portfolio of protein replacement therapies and precision medicines, including small molecules, biologics, and gene therapies that are in early to late-stage development. Pharming is headquartered in Leiden, Netherlands, and has employees around the globe who serve patients in over 30 markets in North America, Europe, the Middle East, Africa, and Asia Pacific.

Our Culture

Pharming is committed to our core values: "We Care, We Collaborate, We Walk the Talk", which is complementary to our focus on self-development of our people, teamwork, leadership and being results orientated. In our growing organization, it is important that employees feel connected and engaged. Our core values enable our mission of bringing the unserved rare disease patients the solutions they need and create a clear pathway forward to meet our strategic goals and objectives.

Overview

Pharming is seeking to hire an Associate Director, Reimbursement and Access (RAD) - Mid-South to support patient and healthcare providers (HCPs) across sites of care in gaining access for patients to Ruconest. Our goal is to ensure that HCPs have the most up to date information when prescribing and working through the approval and logistics processes for Ruconest. Successful execution will involve the RAD being a regional expert in patient access, reimbursement, prior authorization appeal, obtaining financial assistance, and navigation through any complex access related issues. RADs are regionally split across the U.S., supporting Ruconest Account Manager (RAM) territories in their assigned regions. This role will support the US Rockies territory to include AL, GA, NC, VA, TN, MS, SC. This is an individual contributor role.

Key Responsibilities

The Associate Director, Reimbursement and Access (RAD) - Mid-South will be responsible for a wide variety of matters in support of Pharming's growth as we increase the number of both pipeline and marketed products.

Core functions include:

• Handling all coverage, reimbursement and access needs across their territories/regions and work directly with their respective RAM's, Ruconest Patient Advocates (RPAs), Hub Case Managers, National Account Directors (NADs) and customers (HCP facing).
• Work directly with Hub vendor to understand payer coverage issues and assist with prior-authorization (PA) denials and appeals by working with physicians and staff, helping prepare HCPs for Peer-to-Peer needs.
• Proactively track patients from submission of enrollment form through to shipment in order to identify potential issues and work to enable timely resolutions.
• Provide training and education to HCPs on payor specific coverage policies and authorization documentation requirements, appeals processes and patient financial assistance support programs.
• Develop and maintain positive working relationships with both internal team members (e.g., RAMs, NADs, Case Managers and RPAs) and external stakeholders (e.g., physicians, office staff, Specialty Pharmacy partners).
• Work with HCPs and specialty pharmacy to overcome quantity limits or high dollar overrides.
• Escalate and engage the NAD when payer coverage or payment issues are identified, providing detailed specifics on issues, steps attempted to resolve, and identify key items that need addressing with the payer.
• Communicate issues and status with internal stakeholders and leaders (NADs, RBDs, VP of Sales).
• Communicate opportunities and challenges related to patient access issues to internal stakeholders.
• Work collaboratively to improve access and reimbursement tools and processes.
• This is a field-based role; candidate must live within the mentioned territory, ideally local to a major airport.

Minimum Qualifications

• Bachelor's Degree from an accredited university.
• 3 years' experience as a Field Reimbursement Manager.
• 5 years cross-functional experience in the pharmaceutical/biotech industry.
• 2 Years' experience with prior authorization and multi-level appeals.

Preferred Qualifications

• 3 years' experience as a Field Reimbursement Manager for a biologic / buy & bill (physician-administered, IM/SC injectable, IV injection, infusion) drug experience highly preferred.
• Immunology background and rare or ultra-rare disease industry experiencehighly preferred.
• Excellent working knowledge of reimbursement and access challenges in the current healthcare environment.
• Ability to communicate payer coverage criteria and prior authorization/appeals processes to HCPs and staff including prepping HCP's for Peer-to-Peer discussions.
• Experience working with Specialty Pharmacies to resolve access issues.
• Experience working with a Hub to obtain necessary payer information and facilitating next steps.
• Experience working with multiple internal stakeholders (sales, managed markets, patient advocacy, government affairs, etc.)
• Demonstrated ability to apply reimbursement knowledge to address/resolve patient access barriers.
• Possess interpersonal skills including managing and resolving conflict and building strong working relationships.
• Proven track record for consistently meeting or exceeding goals and objectives.
• Proficient in working in a cross functional environment while handling multiple tasks.

Travel Requirements

• Travel as needed (up to 50%) to HCP offices, with or without RAMs, to work with appropriate level stakeholders to respond to coverage or payment issues (i.e., 2 to 3 days in the field).

Compensation & Benefits

• Flexible hybrid work schedule to promote a health work-life balance.
• Competitive compensation package including annual target bonus.
• Long-Term Incentive Program.
• 401(k) plan with company match.
• Paid-Time Off Days.
• 16 Company Holidays per year (typically last week of December up until New Year's Day).

Other Benefits

• Excellent Healthcare Plans including Medical, Dental and Vision.
• Flexible Spending Accounts for Medical and Dependent Care.
• Company-provided Life Insurance, Short-Term and Long-Term Disability Plans.
• Accident, Hospital Indemnity and Critical Illness Plans.
• Pet Insurance Plan.
• On Premise Fitness Center.
• Health & Wellness Program.
• Choice of Mobile Phone for Work Use or Cell Phone Stipend.
• Pharming Academy - Continuing Learning & Development Program.

Additional Information

Pharming is committed as an Equal Opportunity and Affirmative Action employer for all employees and qualified applicants without regard to race, color, sex, gender identity or expression, genetic information, sexual orientation, marital status, race, religion, color, national origin, disability, protected Veteran status, age, or any other characteristic protected under applicable law.

An applicant requiring an accommodation in connection with the hiring process and/or to perform the essential functions of the position for which the applicant has applied should make a request via email to .

Unsolicited resumes from agencies should not be forwarded to Pharming. Pharming will not be responsible for any fees arising from the use of resumes through this source. Pharming will only pay a fee to agencies if a formal agreement between Pharming and the agency has been established. The Human Resources/Talent Acquisition department is responsible for all recruitment activities; please contact us directly to be considered for a formal agreement.

Please note that we review every submission, and we will keep submissions on file for six months.