Director, Payer Relations (Field Reimbursement) AZ, S. CA, IA, MO, NM, NV, OK, TX (DFW)
The PRM Director leads and coaches a team of PRMs who provide technical coverage, coding and payment support to customers in the specialty biologics space. The PRMs provide field reimbursement support for the full GSK Specialty Portfolio and are expected to have deep local area market access expertise. The PRMs work closely with a third-part reimbursement support services vendor to assist customers with access-related questions. The PRMs also interface with a large team of internal matrix stakeholders including Field Sales, Managed Markets, Specialty Payer Account Managers, and others to help enable appropriate patients to access GSK specialty medicines.
The PRM Director must have demonstrated deep technical understanding of coverage, coding, payment and distribution of specialty products and the rules and regulations that govern provision of reimbursement support. The primary responsibility of the PRM Director is to hire, develop and lead a team of PRMs to effectively engage customers to understand key coverage, coding, payment, product acquisition and affordability dynamics for GSK specialty products in their local geography. In addition, the PRM Director provides management oversight and training to their team to ensure that all team members are in compliance with the GSK PRM Standard and ways of working.
The PRM Director must effectively lead a team of internal Matrix stakeholders including field sales, Managed Markets Marketing, Reimbursement Support Services, Payer Accounts and Channel Accounts. Development of effective Regional account plans to optimize access for appropriate patients is a critical success factor.
Key responsibilities for this role include:
• Hire highly qualified team members and work to develop their skills to optimize their ability to provide effective reimbursement support in support of appropriate patients
• Ensure team compliance with the GSK PRM Standard, Ways of working, and relevant rules and regulations that govern provision of reimbursement support services
• Manage the team to ensure that relevant customer insights are shared with relevant partners in support of development of effective access strategies and solutions
• Pull-through key access and affordability messages and strategies developed by the Brand Payer & Access Marketing Team (Managed Markets Marketing)
• Train team members on key technical information related to coverage, coding, payment and affordability
• Identify gaps in PRM capabilities and work with the PRM Field Vice President and Commercial Capabilities to address gaps
• Bachelor's Degree
• Minimum 2 years of experience developing and/or providing coverage, coding and payment information to provider customers for specialty biologic medicines in the US Market in a Managed Markets Marketing, Payer Account Management, Field Reimbursement Manager or equivalent role
• Ability to travel up to 75%
• Must be located near a major airport within the Region- Only covers panhandle of TX, but, may live DFW area
• Valid Driver's License
• Master's Degree in Public Health or Health Administration
• 3-5 years' experience developing and/or providing coverage, coding and payment information to provider customers for specialty biologic medicines
• Thorough understanding of the technical payer policy processes, systems and requirements for coverage, coding and payment for specialty biologics medicines
• Demonstrated understanding of the rules, regulation and risks associated with provision of reimbursement support services and how to monitor and mitigate for those risks
• Experience training and developing others to understand the technical payer policy processes, systems and requirements for coverage, coding and payment for specialty biologics medicines
• Strong understanding and ability to communicate technical elements of coding and billing requirements at the National and Regional level across all settings of care
• Comprehensive understanding of Parts A, B, C and D or Medicare and associated reimbursement dynamics
• Strong understanding of drug acquisition and dispensing in the specialty biologics space (role of Buy and Bill, Specialty Pharmacies, Specialty Distributors, etc)
• Strong understanding of third party reimbursement support service vendors and how to effectively interact in a compliant fashion
• Advanced coding certification
• Demonstrated successful team coaching, management and people development experience
• Track record of strong leadership contributions
• Ability to effectively navigate complex situations with internal and external customers that require sound judgment, problem-solving skills and awareness of rules and regulations that govern provision of reimbursement support services
At GSK, our mission is to improve the quality of human life by enabling people to do more, feel better and live longer. Our three world-leading businesses research and deliver innovative medicines, vaccines and consumer healthcare products. We need a talented and motivated workforce to deliver against our strategy. To achieve this, we strive to attract the best people and to create an environment that empowers and inspires.
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