Job Description

Regional Business Director of Field Reimbursement

The Region Business Director of Field Reimbursement is a field based leadership role supporting the market access strategy for the Sun family of products across the branded business units. This role provides leadership related to health policy, reimbursement, patient access and coverage within an assigned geography managing a team of approximately 7 Field Reimbursement Managers. The person in this role will lead their team of Reimbursement managers supporting primarily the Biologic Dermatology Business Unit, the Specialty Dermatology Business Unit, and the Oncology Business Unit. In this role this individual will serve as a field subject matter expert on access and reimbursement, coding, coverage, payer processes, and payer policies. This individual will have a deep knowledge of U.S. payer landscape and understand the changes associated with Health Care Reform as it relates to patient coverage. As an expert in patient access and coverage the Region Business Director will be expected to have extensive knowledge of local, regional and national payer policies. Their expertise needs to include strong understanding of government and commercial payers, the buy and bill process, working with alternate sites of care, appeals and exceptions processes, CMS coverage determination updates, HUB support and field operations. This individual will need to have a strong ability to manage complexity and work in a dynamic, fast-paced business environment Finally, this individual will be the technical expert coaching their team members on appropriate coding guidelines, CPT, J-code, and Diagnosis code utilization while elevating their understanding of the market access landscape. The Region Business Director will be critical in the process to identify, triage, and elevate reimbursement issues to the appropriate internal and external stakeholders.

Marketplace Knowledge and Acumen

These individuals will support all Market Access initiatives within the field such as coding and coverage, providing approved practice/patient materials, executing on Access In-Services and Access and Reimbursement Speaker’s programs. This individual will need exceptional knowledge of medical benefit, pharmacy benefit, buy and bill products, coding and coverage as it relates to the products supports for the above mentioned teams.

Furthermore this individual should understand the critical medical societies, and spheres of influence which are important to the business needs of the business units they support. Staying abreast of key policy changes or updates will be essential in this role.

The RBD will need an exceptional understanding of Compliance issues as it relates to Market Access job responsibilities and the ability to provide clear and strong guidance to a field team as it relates to these Compliance boundaries. 

Prior experience and knowledge of the complexities of pull through for biologics, oncolytics, injectable, infusible, and oral therapies is preferred.

Strategy and Direction for Field Reimbursement Team.

This individual will serve as a field leader within the Market Access function and is responsible for providing direction and feedback to the Field Reimbursement team members. As a Strategic Leader this individual will be required to have exceptional presentation skills, outstanding oral and written communication skills, and strong interpersonal skills. This position will help the members of their team create local strategic plans outlining access opportunities and devise the tactics and strategies to pull through all appropriate initiatives.

This position will support the National Lead when providing direction to the Field Reimbursement team. As a RBD this business lead will need to be the example of collaboration encouraging routine communication and partnership with other internal stakeholders. These critical business partners include: Strategic Market Directors, National Account Directors, Territory Managers, Region Sales Managers, Corporate Account Directors, and National Sales Directors. 

A major portion of this role will be spent in the field coaching and supporting the Field Reimbursement team. This lead role will be responsible to conduct routine field visits, quarterly business reviews, attend Access programs, and assist in the strategic pull through of key business initiatives. Each Region Business Lead will have approximately 7 direct reports for whom they will be responsible to ensure local execution of all strategic initiatives. 

Key Support for Internal Business Partners

The RBD position will work directly with the newly formed Corporate Account Director team to identify, engage, and support those accounts that present large opportunities for the organization. The RBD will be expected to be the subject matter lead with patient access, coding, coverage, billing and reimbursement in these Corporate Accounts. These individuals will provide appropriate support to the Corporate Account Director as they prepare resources to strategically support patient access in these priority accounts. Understanding the local market dynamics, payer restrictions and guidance, as well as intimately understanding payer processes is essential.

As stated above Extensive knowledge of the National payers, Regional Payers, and Local payer issues. This individual will be expected to work cross functionally with all members of the field teams. Strong collaboration across internal teams with Regional Sales Managers, Corporate Account Directors, Strategic Market Directors, National Account Directors, and Territory Managers.

This position will be critical in collecting field intelligence for internal business partners to assess the market access environment. 

HUB interface and management .

This RBD position will working closely with the Sun Access HUB pulling reports and analyzing issues, trends and opportunities for the team/ organization. A strong business mindset will be essential when working with these reports to mobilize local, regional and national response to access issues. This individual is encouraged to identify pathways or processes that will assist in efficiency and the transfer of data. This position will not only be a conduit to the field delivering insights and opportunities, but this role will play an essential role in identifying process improvements with our HUB Support team.

Working with Payer Marketing

The RBD position will work closely with Payer Marketing to identify resources and tools which may be helpful or essential for their accounts in supporting patient access. This team will provide the necessary information, documentation and insights to support the Payer Marketing team in their build, creation and execution of brand strategy. 

Interface with Training

Finally this team will work closely with the Market Access Training lead to advise on appropriate content, context and resources for the field. The RBD will be responsible to assist the Training team in their efforts of Training new hires on critical business content. 

Education:

A minimum of a Bachelor’s Degree is required. A Master’s Degree is preferred but not required.

Experience:

• Prior experience with field reimbursement of launch products, biologics and buy and bill products is required.
• A minimum of 2-3 years of field leadership along with reimbursement related experience is required.
• Previous Market Access experience is a plus.
• Extensive knowledge of coding, billing, and the Market Access landscape is essential.
• Demonstrated team leadership and strong cross functional collaboration is a must.
• Previous Immunology, Dermatology and Oncology experience is a plus.
• Experience working with both Community and Hospital based practices is required.
• Looking for a documented history of success.
• Candidates should have an advanced understanding of the federal regulatory processes and healthcare policy development especially the Medicare/Medicaid program.
• Direct experience working with the Centers for Medicare & Medicaid Services (CMS) or other key government agencies is a plus.
• This position requires up to 50% travel.

Responsibilities include :

• Effective management and coaching of a field team to execute against access performance metrics for the individual brand teams.
• Incorporate knowledge of dynamic and complex marketplace and business trends to deliver maximum access to the portfolio of Sun products.
• Lead their teams in the build of approved/ compliant local strategies supporting access and coverage of their product portfolio.
• Routinely review national policies and legislation information, identifying important reimbursement issues for input into brand strategies
• Monitor national Commercial, Medicare and Medicaid communications on coverage, coding and payment policy and potential policy changes
• Develop and maintain a relevant network of decision makers and opinion leaders in the field of reimbursement policy
• Strong collaboration and coalition building with industry stakeholders (e.g.; trade associations, advocacy groups, regulatory authorities)
• Anticipate changing payer landscape by demonstrating a deep understanding and knowledge of public payer emerging trends that can impact access for Sun’s branded products and pipeline.
• Translate policy developments into meaningful guidance and strategic advice.
• Significant experience and understanding an ever changing payer environment and its impact on access of products administered in a healthcare setting
• Prioritize team efforts across stakeholders to maximize opportunities, share customer insights and aid the team in obtaining and allocating resources. 
• Lead the reimbursement specialist team in developing and executing Account Plans in cooperation with relevant functions (Sales, Marketing and Pricing)
• Work closely with the Corporate Account Directors supporting access and coverage needs of key accounts.
• Provide inspirational leadership to the reimbursement specialists’ field team.
• Hold team accountable for results and reinforce appropriate customer focused behaviors.
• Incorporate knowledge of dynamic and complex marketplace and business trends to deliver maximum access to the portfolio of Sun products.
• Effectively communicate key legislative and health policy updates to the field sales organization and key external stakeholders
• Anticipate changing payer landscape by demonstrating a deep understanding and knowledge of public payer emerging trends that can impact access for Sun’s branded products and pipeline.

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