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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in access and reimbursement processes, including coding, billing, and specialty pharmacy products. Proven ability to educate stakeholders and develop effective patient support programs within the pharmaceutical industry.
Highest-signal resume keywords
Access And Reimbursement ExpertiseSpecialty Pharmacy ExperienceCoding And Billing KnowledgeManaged Care KnowledgePatient Support Program Development
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Reimbursement AnalysisClaims ProcessingBilling And CodingPatient Access SupportBuy-And-Bill Reimbursement PathwayInjection Network ExperienceAcquisition PathwaysPlan Of Action DevelopmentInventory ManagementPolicy Communication
Soft Skills
Proactive EducationCollaborationProblem SolvingCommunicationStakeholder Engagement
Tools & Technologies
Patient Support Center SystemsNovartis Systems
Certifications & Qualifications
Bachelor’s DegreeValid Driver’s License
Industry Keywords
Managed CareCenters Of Medicare & Medicaid Services (CMS)Medicare Parts B And DIntegrated Delivery NetworkFederal Payer Sectors
About the role
Key responsibilities & impact- Provide proactive face-to-face or virtual education to assigned accounts on access and reimbursement topics
- Serve as the key contact and local market access expert for payer coverage, acquisition pathways, billing and coding, claims processing, reimbursement, and manufacturer support programs
- Support patient access and integrate product-specific programs into office processes and workflows
- Address questions about product ordering, payment, inventory, returns, and replacement
- Work with providers, administrators, billing and coding staff, claims departments, and revenue cycle managers
- Analyze access and reimbursement problems, issues, trends, and opportunities and provide solutions
- Support local coverage decisions and communicate policy changes internally and externally
- Establish Novartis-sponsored patient support programs
- Interface with the Patient Support Center on case management, issue resolution, reimbursement support, and office staff education
- Collaborate with cross-functional Novartis associates and third-party affiliates
- Identify and report adverse events through established Novartis systems
- Assess access situations and develop Plans of Action within the assigned geography
- Establish preferred acquisition pathways and support buy-and-bill processes, including white bagging, clear bagging, brown bagging, and alternate sites of care
- Educate stakeholders on ordering, payment, inventory, returns, and replacement logistics
- Engage non-prescribers including pharmacy, system leadership, financial counselors, office administrators, and revenue cycle managers
- Meet and exceed designated corporate objectives and support successful patient access to prescribed medicines
Requirements
What you’ll need- Bachelor’s Degree required
- Minimum three to five years' experience in public or private third-party Reimbursement arena or pharmaceutical industry in managed care, clinical support, or sales
- Experience with specialty pharmacy products acquired through Specialty Pharmacy networks or specialty distributors
- Experience with coding, billing and in office support programs
- Specialty pharmacy experience
- Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare Parts B and D a plus
- Knowledge of Managed Care, Government, and Federal payer sectors, as well as Integrated Delivery Network/Integrated Health Systems a plus
- Must live within assigned territory
- Fully valid and unrestricted driver’s license required
- Superb knowledge of buy-and-bill reimbursement pathway
- Experience working with established injection networks
Benefits
Comp & perks- Reasonable accommodations for qualified individuals with medical restrictions
- Equal opportunity employment and accessibility support