Reimbursement Account Manager/National RAM Team Lead

PLEASE NOTE: THE CANDIDATE FOR THIS ROLE MUST RESIDE IN FLORIDA.

Who we are.

Dendreon is making the battle against cancer personal. Our flagship product PROVENGE^® (sipuleucel-T), was the first FDA approved immunotherapy for the treatment of metastatic castrate resistant prostate cancer and is made from the patient's own immune cells.

If you are looking to positively impact the lives of patients, we want you to join our team. We have Immunotherapy Manufacturing Facilities located in Seal Beach, CA and Union City, GA. A sizeable Research & Development group based out of Seattle, WA, and a highly skilled Commercial team countrywide.

Core Values:

• Put Patients First. Every day is a new opportunity to improve the lives of patients living with cancer
• Act with Integrity. Be honest, transparent, and committed to doing what’s right in every situation.
• Build Trust. Building trust takes time. Engage teammates, be candid and transparent. Over communicate and seek feedback.
• Raise the Bar. Harness continuous improvement, foster innovation and elevate our people.
• Drive Results. Be accountable and execute – we win together when everyone performs.

Your Role:  The Reimbursement Account Manager (RAM) is responsible for unimpeded patient access to Provenge within the assigned geographical area. The RAM will develop and implement strategies that will maximize business opportunities for growth. This position reviews national, regional, federal and state Medicaid payer policies to effectively reduce medical policy restrictions and practice reimbursement barriers. The RAM will effectively partner with medical practice decision makers, CFO’s, CEO’s, pharmacy and medical directors, purchasing departments, key stake holders within community-based urology and oncology practices along with academic and community based hospitals, medical centers, clinics, etc. to effectively remove reimbursement obstacles to PROVENGE utilization.

RAM Responsibilities:

• Removes practice reimbursement barriers by providing resources and creates access to PROVENGE, related to coverage and coding.
• Provides market place feedback in a timely manner to corporate leadership team on customer coverage and reimbursement trends, competitive updates and industry issues and opportunities.
• Educates providers on patient assistance programs and other resources.
• Updates and educates accounts on key Commercial and Government payor policies that may impact access to treatment with PROVENGE.
• Assists members of sales force in all aspects of PROVENGE coverage, coding and reimbursement, including access, pull-through, Key Opinion Leaders (KOL) and champion development as it relates to coverage, coding and reimbursement.
• Develops strategies for removing reimbursement barriers and effectively educates customers to increase reimbursement confidence.
• Serves as a resource to accounts and internal Dendreon staff regarding local, regional and national payor policies; reimbursement regulations and processes (i.e., eligibility and benefit verification, pre-authorization, billing, coding, claims, and appeals/grievances); practice management; Medicare and Medicaid rules and regulations; HIPAA.
• Acts as the liaison between LASH and internal/external customers on all aspect of coverage coding and reimbursement.
• Records all Regional Payor Provenge medical policies and contact information in SFDC.
• Complies with all OIG / FDA and corporate policies and procedures.

National RAM Team Lead Responsibilities:

• Develop and implement strategic plans for field reimbursement activities, aligning with overall company goals.
• Lead and mentor the field reimbursement team, fostering a culture of trust, integrity and continuous improvement.
• Develop and deliver proactive reimbursement education resources for healthcare providers and internal stakeholders.
• Ensure the team effectively addresses reimbursement inquiries and resolves issues in a timely manner.
• Develop and implement best practices for reimbursement processes, including appeals and prior authorization procedures.
• Analyze reimbursement data and metrics to identify trends and opportunities for improvement.

Job Requirements:

• BA or BS degree required. MBA or advanced degree preferred.
• Minimum of 5 years’ experience in the pharmaceutical/biotech/life-sciences industry including 3-5 years healthcare coverage, coding, and/or reimbursement experience required.
• Experience in oncology/urology specialty is preferred.
• Experience working in the buy and bill area of reimbursement is required.
• Must process an in-depth understanding of coding, coverage and reimbursement across all sites of care (community, academic, hospital, IDN) and the ability to apply this knowledge to address individual customer concerns.
• Broad knowledge of Medicare, Medicaid, Managed Care, Third Party payors is required.
• High level of sophistication/interpersonal skills needed to interact with Insurance Company Medical Directors, practice administrators, CEO, CFO, Pharmacy and practice Medical Directors.
• The Reimbursement Account Manager (RAM) will cover multiple regions and thus significant overnight travel is required, estimated at 60%.

Working Conditions and Physical Requirements:

• Ability to sit or stand for extended periods of time 
• Intermittent walking to gain access to work areas
• Finger dexterity sufficient to use a computer and to complete paperwork activities
• Vision sufficient to use a computer, to read written materials and to complete paperwork activities; Hearing sufficient to communicate with individuals by telephone and in person

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