Regional Access & Reimbursement Associate Director
- Boston, MA
- Permanent
- Full-time
- 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 60% within assigned geography
- Maintains compliance with Vertex SOPs and guidelines
- 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
- Bachelor’s degree in relevant field required; Master’s/Advanced degree preferred
- 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
- Field Based, Western States