PATIENT ACCESS AND HEALTHCARE POLICY MANAGER
SCOPE OF POSITION
Zionexa is a dynamic and growing international company, developing and commercializing molecular imaging companion diagnostics (CDx’s) for targeted therapies in Oncology that will help clinicians find the right treatment for the right patient at the right time. Our goal is to improve patients’ pathways and overall quality of life.
The FDA has approved Cerianna (Fluorestradiol F-18) a molecular imaging agent for use in Positron Emission Tomography (PET) imaging for the detection of estrogen receptor-positive lesions as an adjunct to biopsy in patients with recurrent or metastatic breast cancer. Cerianna is the 1st FDA approved F-18 PET imaging agent specifically indicated for use in patients with recurrent or metastatic breast cancer.
This is an exciting time for Zionexa as we begin our journey. Come be a part of an outstanding international team, one that is striving to make positive impacts in peoples’ lives. As we begin with the launch of Cerianna, we are looking for an experienced Patient Access & Healthcare Policy Manager to join us on our journey in developing, training and managing a best in class reimbursement support services team.
The successful candidate will be responsible for the development and operations of a new platform to deliver best in class reimbursement support services to the company’s customers. The Patient Access & Healthcare Policy Manager will administer, implement and educate the providers on appropriate billing methodology, work with payors to develop payment policies for product at both local and national levels. The position will onboard, develop and manage a team of Regional Payor Reimbursement Specialists
ESSENTIAL DUTIES & RESPONSIBILITIES:
- Provide expert guidance to imaging sites to ensure accurate claims submissions, best practices sharing for prior authorization and appeals, scheduling tips, understanding of reimbursement landscape, liaise providers with payors where appropriate.
- Educate healthcare professionals on product reimbursement information and processes, as well as helping providers understand key payor policies related to Zionexa products.
- Plan, develop and operate the company’s reimbursement support services, with the support of external vendors.
- Support development of protocols and guidelines that govern call handling, benefit investigations, prior authorizations and patient assistance.
- Develop and maintain supportive materials for reimbursement guides.
- Present and develop in-person and online training for product reimbursement.
- Support customer processes and direct interactions with both imaging groups and payors including on-site visits and assist in resolving rejected claims.
- Manage routine operations including web platform, call center and on-site support.
- On-board, manage and develop a team of Regional Payor Support Specialists.
- Represent the company at industry reimbursement policies forums.
- Manage WAC and cost reporting to government agencies and pricing compendia.
- Educate and work with the Sales Team to ensure access for local reimbursements.
- Performance monitoring, prepare and analyze related reporting, driving corrective actions and improvements to ensure professional, timely and compliant delivery of services.
- Monitor national private and public payors policies that may impact product coverage.
- Support Medical Affairs to establish appropriate use criteria and incorporate product into NCCN
- Provide regular status reports and tracking of customer education/interaction and results.
- Assist with related duties as needed.
- Requires a Bachelor’s degree in Science, Healthcare, Regulatory or Business related field.
- Certified Professional Coder preferred.
Job Knowledge, Skills & Experience
- Minimum of 5 years’ experience in health and payment policies
- Prior management and team development experience required
- Existing relations in the payor industry.
- Experience in working with a cross functional environment including Sales, Regulatory, Clinical, Legal, Finance, IT and other areas.
- Demonstrated ability to drive process improvements, problem solving and proven results.
- Thorough knowledge of ICD9 / 10 coding.
- Familiarity with electronic payor submission.
- CERNER / EPIC knowledge preferred or other claims management systems.
- Prior experience in both hospital and private practice billing environments.
- Excellent communication, organization, analytical, problem solving, presentation and computer/pc skills to include Office 365, CRM software (Salesforce…) and group collaboration applications.
- Strong customer service focus.
- Requires extensive travel.
- Requires a valid state in residence drivers license in good standing.
- Occasional occupational exposure to radiation.
- Occasional exposure to moderate environmental variations, above average noise levels, and/or some unpleasant substances.
Physical Demands (The physical demands described are representative of those that must be met by an employee to successfully perform the essential functions of the job).
- Requires the ability to travel in excess of 50% of the time.
- Some international travel may also be required.
- Light to moderate physical exertion, including occasional standing, bending, reaching, lifting and ability to carry light to moderate heavy loads of up to 40 pounds (any heavier lifting in excess of 40 pounds would be with assistance).
Zionexa offers a comprehensive employee benefits program including a 401(k) with match, Life, STD, LTD, Health, HSA, Dental, Vision, Vacation, Sick Time….
At Zionexa, we embrace diversity in our principles, culture and our values. Zionexa is proud to be an Equal
Opportunity employer. As such, we do not discriminate based on race, religion, color, national origin, gender, gender identity, gender expression, sexual orientation, age, disabilities, protected veteran or other protected characteristics.
To ensure equal employment opportunities to qualified individuals with a disability, Zionexa, U.S. will make reasonable accommodations for the known disability of an otherwise qualified individual, unless undue hardship on the operation of the business would result.
Recognizing that it will not be possible to respond to every applicant expressing interest, and we will reach out only to those meeting the qualifications, we thank you in advance for your interest in Zionexa.
Keep watching our website as we continue to grow!
Please no phone calls or emails to any employee of Zionexa regarding any position opening. To all Agencies, resumes submitted by search firms/employment agencies to any employee at Zionexa by email, internet or in any form and/or method will be deemed the sole property of Zionexa, unless a search firm/employment agency was engaged by Zionexa for a particular position and a valid agreement with Zionexa was in place. Should a candidate who was submitted outside of the Zionexa agency process be hired, no fee or payment of any kind will be paid.