Payer Relations Manager- AR/LA
Job Description Summary-This is an exciting opportunity to work with an innovative medication for an unmet need into the US market. The position will provide a unique opportunity with the primary focus of maximizing patient access to specialty products, working directly with healthcare professionals.
o The Payer Relations Manager (PRM) team provides important reimbursement and product access assistance to healthcare professionals attempting to obtain the product for their patients. The main goal of the team is to provide reimbursement and educational services in a highly competitive service environment. Responsibilities for this function include working with the provider offices, hospitals, patient support line and state societies to maximize access to a much needed therapy.
o Candidates must possess a solid track record of success working in a matrix environment. They will interface with SAMs, RAMs, MSLs, INEs, Brand and Sales team within GSK.
Job Description-The Payer Relations Manager (PRM) is responsible for educating healthcare professionals about important product reimbursement information and processes as well as helping providers understand GSK Access Support Services that may be available to help appropriate patients access GSK specialty medicines. PRMs are responsible for educating providers on key payer policies related to GSK specialty products and work to communicate impact of these payer policies on payer access back to the Payer Specialty Account Managers. This role reports into a Director of Payer relations. Qualified candidates must possess a solid track record of success working in a matrix environment and must demonstrate effective leadership of non-direct reports. PRMs routinely interface with Payer Specialty Account Managers (SAMs), Specialty Account Directors that interface with Specialty Pharmacies (SCADs) and Specialty Brand Field Sales teams.
• Ability to travel up to 75%
• Must be located near a major airport within the territory.
• Valid driver's license.
• Minimum of 5 years experience in pharmaceutical and/or health care industry including a specialty division, or experience in Provider Relations/Reimbursement Department of a third-party payer or insurance company.
• MBA, MPH or other advanced degree
• Basic knowledge of the payer environment including state, federal, private third party reimbursement issues, methodologies and policies for physician- and self-administered drugs
• Strong customer focus with building relationships, issue identification and resolution, problem-solving and project management skills
• Ability to operate independently and handle multiple projects with a high degree of initiative and operate successfully in matrix environment reporting into reimbursement function while deployed in the field
• Highly organized, strategic thinker with excellent verbal, written and presentation communication skills
• Reimbursement experience for immunology, oncology or other specialty infused products in a buy and bill setting across all sites of care
• Strong knowledge of provider office and hospital outpatient department reimbursement environments, regulations, customers, and market dynamics.
• Comprehensive understanding of Medicare Parts A, B, C, D and knowledge of commercial insurance reimbursement.
• Understanding of the miscellaneous and permanent J code, Q code and possible issues surrounding appropriate billing.
• Experience working with reimbursement call centers for patient access
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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