The Patient Support Manager will provide field-based support and expertise to help resolve patient access issues, educate offices and hospitals on appropriate billing and coding for Otsuka products, and provide educational services within relevant sites of care. The PSM will work physician and hospital office support staff, pharmacists, and third party vendors (Helpline, Copay Card, etc.)
- Manage daily activities that support appropriate patient access to Otsuka products across relevant sites of care and work as an extension of the patient support and reimbursement support services offered to patients and providers
- Provide education to accounts to help facilitate patient access, such as reviewing coverage and access options across Otsuka’s product portfolio, outlining prior authorization requirements across relevant payers, and discussing alternate funding/financial assistance programs that may be available regionally for patients
- Review appropriate billing and coding for products, provide support for resolving reimbursement issues, and help ensure appropriate education to avoid future reimbursement hurdles
- Educate physician and hospital office support staff on the use of Otsuka’s patient support and reimbursement support services, including a web-based provider portal, enrollment forms, and templates
- Present and educate sites on relevant reimbursement topics (ie, ICD-10, Healthcare Reform, Exchanges, ACOs, Discharge and the Importance of Continuity of Care, etc.)
- Support sites of care with understanding local payer coverage and reimbursement trends
- Lead training related to product reimbursement for internal stakeholders, as appropriate
- Communicate reimbursement concerns and issues with appropriate internal stakeholders
- Work collaboratively with Market Access Team to escalate potential payer issues
- Conduct planning meetings with Account Managers to provide appropriate support
- Act independently and to take initiative with minimal supervision from manager
- Provide consultative reimbursement support to internal and external stakeholders
- Able to troubleshoot reimbursement issues
- Ability to diffuse situations within an office or hospital due to reimbursement concerns
- Tailor approach and message to relevant stakeholders (ie, nurse vs HCP vs biller)
- Minimum of a Bachelor’s degree, preferably in a science-related field
- Minimum of two years of experience in public or private third-party reimbursement; previous field reimbursement manager experience preferred. Must have worked with a pharmaceutical, biotech, device manufacturer, or payer in a reimbursement capacity, or in a healthcare postion that involved billing, or as a contract position through a reimbursement consulting agency.
- Must have specific practice management, billing and/or coding experience for drugs, biologicals, or devices under a “buy & bill” and specialty pharmacy model.
- Previous mental health experience preferred.
- Must be able to provide support to prescribers and their staff by addressing access barriers for appropriate patients to Otsuka’s products, which requires a broad knowledge of the claims’ revenue cycle process.
- Possess an understanding of reimbursement considerations from a patient and provider perspective, with an ability to effectively interact and navigate within various sites of care (i.e., physician office, CMHC, Mental Health Facility, pharmacy, hospital outpatient department etc.).
- Must have general payer policy knowledge including public and private payers, foundational knowledge of benefit verifications and prior authorization requirements and knowledge of reimbursement processes across various sites of care.
- Ability to listen effectively and the capability to effectively communicate ideas and data both verbally and written in a persuasive and appropriate manner to a broad array of stakeholders
- Excellent organizational skills
- Ability to work in a virtual setting/across time-zones, (i.e., making effective use of communication tools (WebEx, and video conferencing, etc.)
- Willingness to adapt to new approaches to doing business
- Comfortable in dealing with ambiguity
- Spirit of innovation, curiosity, creativity and perseverance
- Adaptable to an open space work environment
- Eagerness to embrace challenges and the freedom to explore
- Passion for the work and drive to maintain excellence
- Desire to continuously improve and grow skill set
Otsuka Pharmaceutical Company is a global healthcare company with the corporate philosophy: “Otsuka-people creating new products for better health worldwide.” Otsuka researches, develops, manufactures and markets innovative products, with a focus on pharmaceutical products to meet unmet medical needs and nutraceutical products for the maintenance of everyday health.
In pharmaceuticals, Otsuka is a leader in the challenging area of mental health and also has research programs on several under-addressed diseases including tuberculosis, a significant global public health issue. These commitments illustrate how Otsuka is a “big venture” company at heart, applying creativity in everything it does.
Otsuka Pharmaceutical Company is a subsidiary of Otsuka Holdings Co., Ltd. headquartered in Tokyo, Japan. The Otsuka group of companies employed 50,000 people worldwide and had consolidated sales of approximately USD 11 billion (€ 9.9 billion) in 2016.
All Otsuka stories start by taking the road less travelled. Learn more about Otsuka Pharmaceutical Company on its global website at www.otsuka.co.jp/en. Learn more about Otsuka in the U.S. at www.otsuka-us.com.
This job description is intended to describe the general nature and level of the work being performed by the people assigned to this position. It is not intended to include every job duty and responsibility specific to the position. Otsuka reserves the right to amend and change responsibilities to meet business and organizational needs as necessary.
Otsuka is an equal opportunity employer. All qualified applicants are encouraged to apply and will receive consideration for employment without regard to their protected veteran or disabled status, or any protected status.