Field Access Manager - South Central

See Yourself at Telix

As a member of the Market Access Team, The Field Access Manager is responsible for the Access and Reimbursement for the Telix brand portfolio within an assigned geography. Reporting to the Manager, Market Access, an FAM must have a ‘patient-first’ mindset and willingness to advance pull-through efforts related to patient access for Telix products. In addition to Site of Service Access and Reimbursement responsibilities, the FAM will maintain a portfolio of regional payers and be responsible for medical policy planning and development, policy review, and favorable placement of the Telix brand portfolio within regional commercial medical policies, remove restrictions to unfavorable policies, placement of Telix products on state Medicaid fee schedules, and favorable formulary status where applicable. This role is hybrid in nature, and will support both sides, market access and reimbursement, for the drugs lifecycle, for both current products and pre and post launch support of new products.

Key Accountabilities

• Work directly with site of service support staff, providers, and other important stakeholders involved with patient access for all things reimbursement, including but not limited to, education around billing and coding, appeal or denials, patient support services, and appropriate use criteria for the Telix brand portfolio
• Educate site of service staff on medical policy and web-based educational links to provide information on relevant reimbursement topics or policy criteria
• Develop KOL relationships to support patient advocacy, and leverage relationships for grassroots efforts when needed
• Be the reimbursement and payer policy subject matter expert as it relates to Telix brand portfolio and competitor landscape, and understand all applicable reimbursement regulations for Medicaid, Medicare and Commercial payers
• Establish and maintain knowledge of the local and national payer landscape, and be able to clearly communicate challenges and opportunities to internal and external stakeholders
• Perform Access Reviews within Key accounts to determine if the account is receiving reasonable and customary reimbursements for services provided
• Manage Regional Payer Accounts from pre-commercial through launch and maintenance within an assigned geography
• Engage with policymakers, industry associations, and advocacy groups to shape healthcare policies and reimbursement practices locally and regionally
• Deliver Market Access Value Proposition to Population Health Decision makers, Medical Directors, Policy Development Directors, Drug Utilization Review Committees, and Formulary Managers where appropriate
• Develop and execute strategy for policy creation and implementation with assigned regional payers, and remain accountable for the medical policy outcomes, favorable placement, and removal of barriers to access within regional payer medical policie
• Monitor and analyze healthcare policies, regulations, and reimbursement frameworks that impact market access and reimbursement, and provide updates to site of service accounts, internal and external stakeholders
• Organize and complete administrative responsibilities in a timely manner, including but not limited to, case reporting, success and challenges reporting, expense reporting, vacation, and time-off reporting

Education and Experience

• BA/BS Degree or equivalent work experience required
• 5+ years' experience in the pharmaceutical or biotech industry, preference to Market Access Roles
• 3+ years of experience in healthcare coverage, coding and/or reimbursement
• Direct experience with buy and bill products, Medicare Part B and miscellaneous codes
• Diagnostic Radiology and Oncology Experience strongly preferred
• Previous experience working with billing, coding and medical claims
• Understand the various nuances of the different claims settings or sites of care; physician office, hospital outpatient, IDTF
• Well versed in implementing and educating on various payer policies and payment methodology for commercial and government insurance plans
• Experience working with regional, national or government payer entities surrounding policy development and implementation
• Understanding of oncology buy and bill model with commercial and government-based payers; recent experience preferred
• Knowledge and understanding of specialty markets, HUB/Reimbursement support and patient access programs
• Strong influence and collaboration skills for external and internal stakeholders
• Ability to travel 20-40% depending on the needs of the region and customers