Express Scripts Prior Authorization Jobs in Utah

About This Role

Biogen is searching for a dynamic and seasoned Access and Reimbursement Manager to join our US Neuropsychiatry Franchise. This role is pivotal for ensuring patient access to our products and a positive customer experience through education on effective script fulfillment processes.

In this remote-based, regional scope position, the ARM is the subject matter expert for reimbursement, prior authorizations, coding, pharmacy distribution models, and patient access issues related to administration of therapy by practices treating postpartum depression (i.e., women's health, perinatal-focused psychiatrists, and PCP offices).

Collaborating closely with the Neuropsych Account Managers (NAMs) and other customer-facing teams as necessary and appropriate, the ARM will strategically educate and support appropriate account stakeholders - i.e., healthcare providers and office staff involved in fulfillment processes - on access and reimbursement and script pull through processes, distribution pathways, specific payer policy requirements, and clinical information when appropriate.

What You'll Do

• Engage and work strategically with account decision-makers, relevant HCPs, and support personnel to deliver educational information that facilitates patient access and reimbursement for PPD therapy.
• Educate stakeholders in key accounts who are involved in the script fulfillment process, with a focus on successful script submission, getting the script to the proper pharmacy, navigating the prior authorization process, and setting fulfillment process expectations with PPD patients.
• Work closely with the account stakeholders to identify potential opportunities to improve fulfillment processes.
• Act as the subject matter expert on all aspects of reimbursement, distribution options, and public and private payer policy coverage determination criteria relevant to specific customer's practices.
• Collaborate closely with Neuropsych Account Managers (NAMs), Trade, Payer, and Patient Services teams on script fulfillment issues (e.g., Specialty Pharmacy, account access and reimbursement management, etc.) to support pull-through and ensure that issues are resolved in a timely manner.
• Organize and lead virtual as well as in-person access and reimbursement presentations to key account stakeholders, leveraging expert-level acumen on national and local payer payment trends, public and private payer dynamics, and pharmacy benefit reimbursement practices.
• Serve as the regional reimbursement resource for key customer accounts providing both technical and practical advice to avert or resolve reimbursement issues and support patient access across the journey.
• Promote a culture of compliance to ensure that all activities are fully compliant with Company policies and procedures, applicable laws, regulations, and industry standards.

Who You Are

You are a strategic thinker and authority in access and reimbursement, with a demonstrated track record of high performance. You have robust expertise in public and private payer policies, prior authorization policies and procedures, specialty pharmacy distribution models, and access pertaining to controlled substances. You are a collaborative, resourceful, and tenacious individual who thrives in fast-paced environments and approaches challenges with creativity and determination. You have a unique ability to distill complex payer information in a streamlined and digestible manner for your stakeholders. You put the needs of patients and those who care for them above all else and have a passion for serving them.

Qualifications

• BA/BS required, preferably in one of the following areas: Business Administration, Communications, Healthcare Management, and Marketing.
• The ideal candidate will have 7+ years of access and reimbursement experience, with a successful track record across field reimbursement, clinical education or pharmaceutical account management of products that required significant payer and reimbursement support; specific emphasis on limited distribution network and controlled substances.
• Comprehensive understanding of all aspects of reimbursement models (coding, coverage, and payment), including complete understanding of Commercial and Medicaid benefit designs and ability to locate applicable coverage policies.
• Demonstrated advanced level of expertise with e-Prescribing and Prior Authorization processes.
• Specialty Pharmacy, HUB and/or Patient service model experience, including experience with financial assistance programs.
• Proactive and resourceful problem-solver with excellent interpersonal skills, exemplary and collaborative work ethic, and an ability to manage multiple and often-evolving strategic priorities.
• Excellent written and verbal communication and presentation skills, tailored to various levels of internal and external audiences up to and including executive audiences.
• Remote role with travel required - customer engagement will be virtual as well as in-person

Additional Information