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Director Patient Reimbursement Services Strategy & Operations

Reference Number: 2837
Location: MA

Our client is a leading global pharmaceutical company.  They have asked us to assist them in their search for a Director Patient Reimbursement Services Strategy & Operations.

The Director Patient Reimbursement Services Strategy & Operations will personally oversee the management of the non-distribution process for attaining commercial drug, free drug, and support.  This is the person who will be looked at by the sales force, market access group, providers, and patients for solutions.  This critical role requires a seasoned professional with leadership experience with multiple launches across the Bio/Pharma industry.  The incumbent will lead the strategic design, implementation and operations for the company’s patient reimbursement services programs.

Major tasks and responsibilities will include:

  • Supports all inline and new oncology products, both oral and injectable.  This includes supervising 2 separate call centers, separate copay program and PAP program vendors.
  • Responsibilities include but are not limited to Patient Reimbursement HUB, Financial Support Programs, Case Management Support and related patient support programs.
  • The role functions as a subject matter expert on patient reimbursement support services and collaborates cross functionally within the commercial organization to design and implement programs that support the company’s patient access objectives.
  • Works closely with several cross-functional stakeholders including US Market Access, Commercial Operations, Marketing, Patient Advocacy, Sales, Legal, Medical and Market Analytics along with relevant external customers and stakeholders.
  • Has significant interaction with Senior Commercial Operations and Legal leadership to accomplish overall business objectives.
  • Oversees existing buy and bill patient reimbursement access program day to day operations with a focus on operational excellence in support of patient and brand objectives and company business requirements.
  • Manages external partner performance against contractual arrangements and to budget.
  • Maintains program SOPs, exceptions processes, workflows, scripting, training and reports.
  • Works with internal Commercial Operations, Legal and Medical teams for approval.
  • Negotiates and executes contracts / SOWs and budgets for desired services.
  • Develops project timelines for new and enhanced services and manages through to completion.
  • Identifies and communicates strategic insights and trends in health plan coverage, healthcare reform, patient access and provider needs.
  • Supports Field Payer Team reimbursement needs with strong communication and timely customer service to address customer needs.
  • Develops strategic recommendations and implementation plans for oral oncology patient support services.  Achieves brand specific patient access objectives and KPI’s at launch and throughout the product lifecycle and ensures that operations are in place to provide optimal reimbursement support at launch.
  • Leads the design, implementation and ongoing management of all patient reimbursement HUB services programs.
  • Develops performance dashboards and interprets hub data for purposes of assessing market access trends, hub program utilization, and performance against defined KPIs.
  • Develops and maintains SOPs and business rules related to all US patient support.
  • Analyzes Medicare policies that restrict access and work with payer teams to develop access strategies.
  • Supports the annual brand planning process with data driven reimbursement insights.
  • Provides strategic insights into Marketing to develop compliant content for the company’s US reimbursement support website.  Drives material through marketing review process as required.
  • Partners with Patient Advocacy initiatives and external support organizations to gather and incorporate insights into patient support strategy for existing and new products.
  • Demonstrates fiscal discipline and accountability to effectively and efficiently manage external partners and vendors performance through appropriate metrics.

We seek candidates with the following qualifications:

  • Bachelor’s degree required.  MBA preferred.
  • Requires 10+ years of experience within the biotech/specialty pharmaceutical/pharmaceutical industry.
  • At least 7+ years of proven experience working with or in Patient Access call center HUB operations.
  • Minimum of 3 product launches.
  • Excellent analytical (qualitative and quantitative), strategic thinking, creativity and problem solving skills.
  • Ability to influence senior management with accountability for decision making in a launch environment.
  • Self-directed, hands-on approach, comfortable with broad and varied job responsibilities.
  • Comfortable functioning with ambiguity.
  • Mentoring / leadership ability.
  • Oncology/Specialty launch experience.  Ideally with both oral and injectable products.
  • Track record of successfully managing and leading vendor relationships from both a strategic and operational perspective and achieving results.
  • In depth knowledge of pharmaceutical manufacturer compliance requirements, patient confidentiality (HIPAA regulations), product reimbursement and product access.
  • Knowledge and experience in Medicare Parts A-D, Medicaid, and private payer policies, reimbursement process, health policy, areas of coverage, payment, coding, Specialty Pharmacy, and buy and bill.
  • Experience with Commercial Brand Planning process, able to translate brand disease state and business drivers into patient support programs and operational requirements.
  • “Customer First” customer service orientation.  Puts the customer at the center of all business activities.

 

Do you have the skills and experience we seek and want to advance your career with one of the world’s leading companies? If so, please email your resume as a Word attachment to us, reference 2837. No calls or faxes, please. Include your daytime phone number and we will contact you confidentially or reply to your email.