Associate Director, Field Reimbursement - Northwest Region

Overview:

Reporting to the Field Reimbursement Director, Lead, the Associate Director, Field Reimbursement will optimize access to Alnylam products in his/her region by understanding and addressing reimbursement and patient access challenges. This position requires a professional who can leverage his/her technical expertise and experience to deliver educational, reimbursement in-service programs to all sites of care (Medical Doctors Office, Alternative Infusion Centers, Hospital Outpatient Department, etc.) and manage access and reimbursement issues by initiating as well as leading action plans to resolve these issues. 

A key component of this role is the ability to establish and deepen customer relationships through quality interactions with access and reimbursement focused external stakeholders at targeted strategic accounts.  As such, extensive knowledge of ‘buy and bill’ products and prior experience with high-touch, specialty products are essential. 

The Field Reimbursement Team is a critical part of the commercial strategy, working closely with National Account Leads (NALs), Health Systems Directors (HSDs), Regional Account Leads (RALs), Site of Care Directors, Patient Services, the broader Reimbursement team, and Sales to support Alnylam’s patient-focused vision of harnessing a revolution in biology for human health.

The successful candidate must be passionate about science and deeply motivated by the quest of delivering value to patients with the long-term success of the company in mind.  He/she will work collaboratively with both internal and external stakeholders to build tactical plans to execute strategic imperatives.

This position supports the Northwest region, which includes the following states: Alaska, Idaho, Montana, Nebraska, Oregon, Washington, and Wyoming.

Key Responsibilities:

• Optimizes access to the full Alnylam portfolio of products by ensuring that provider accounts understand access and reimbursement dynamics
• Proactively identifies trends impacting barriers to access or reimbursement and creates solutions                                                                                      
• Works with internal stakeholders and providers to support treatment pathways for patients
• Proactively engages with key stakeholders in accounts, including Intake/Authorization teams, billing compliance, Finance executives (Revenue Cycle, Revenue Integrity), Infusion Center management and decision-makers and key Pharmacy Stakeholders
• Responsible for identifying, addressing and supporting education to resolve outstanding claim payment issues
• Provides mentorship and guidance to case managers and field reimbursement managers on case-specific complex PA/Appeal issues
• Provides case-specific PA/Appeal support and site of care options for the rare business
• Maintains relationships with Medicare Administrative Contractors (MACs) to optimize coverage for Alnylam therapies and monitors Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs)
• Works with Public Policy & Government Relations team on engagement strategies and tactics regarding MACs or local policy changes as well as state-level public policy initiatives
• Utilizes reporting dashboards to track critical metrics and key performance indicators (KPIs)
• Ensures compliance with all corporate and industry policies in collaboration with Alnylam Legal, Regulatory and Compliance

Qualifications:

• Bachelor’s degree required
• 5+ years prior pharma/biotech or other related and relevant healthcare experience
• 3+ years of field reimbursement experience in “buy and bill” preferably in rare disease, oncology, specialty products and/or infusions/injectables
• Established relationships with Medicare Administrative Contractors (MACs) highly preferred
• Strong knowledge of the US payer landscape
• Deep understanding of both medical benefit and pharmacy benefit across payer types (Medicare, Medicaid, commercial, VA/DoD, etc.) and sites of care (Hospital Outpatient Department, free standing centers and home infusion)
• Proven ability to identify key access and reimbursement barriers to treatment and design effective resolution plans
• Exceptional professional communication, interpersonal and problem-solving skills necessary to interact with decision makers (CFO and other C-suite level stakeholders)
• Demonstrated ability to lead without authority in a highly collaborative matrix and fast-paced environment
• Self-starter who is enthusiastic about rare disease and Alnylam’s core values: fiercely innovative, open culture, purposeful urgency, passion for excellence, and commitment to people
• Ability to travel up to 50%
• Must reside in geography or within 75 miles of the boundary and with reasonable proximity to a mid-size or larger airport

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