Sr. Advisor, Payor Relations and Engagement; Cell & Gene Specialty Pharmacy

What Advanced Therapy Solutions Contributes to Cardinal Health

Advanced Therapy Solutions (ATS) is dedicated to supporting biopharma pioneers in delivering cell and gene therapies (CGTs) to patients who need them. From clinical development to commercialization, our experts partner with pharma and payers to ensure these critical therapies reach patients. We have processed over 15,000 CGT orders and support more than 425 active sites of care administering CGTs.

This new specialty pharmacy will serve manufacturers, providers and patients in the cell & gene space (among other areas). The Sr. Advisor, Payor Engagement Executive (Cell & Gene Specialty Pharmacy) will focus on payor engagement and negotiation.

Targeting individuals nationwide (fully remote)

• Building a Specialty Pharmacy: Develop and enhance specialty pharmacy capabilities to support the distribution and administration of CGT products.

• Payor Relations: Develop and maintain strong relationships with payors to facilitate smooth negotiations and resolution of coverage issues.

• Individual Case Negotiations: Negotiate agreements with payors to secure coverage and reimbursement rate for advanced therapy / CGT products.

• Prior Authorizations: Manage the prior authorization process for CGT products, including outreach to providers to collect all necessary documentation, submission to payor, follow-up, and resolution of authorization requests.

• Expanding Distribution Channels: Partner with CGT manufacturers to expand their distribution channels, ensuring broader access to innovative therapies.

• Claims Adjudication: Oversee the claims adjudication process, ensuring timely and accurate processing of ATSP claims for CGT treatments.

• Compliance: Ensure all contracting and claims activities comply with regulatory requirements and company policies.

• Documentation: Maintain comprehensive documentation of all negotiations, authorizations, and claims activities.

• Collaboration: Work closely with the pharmacy team, healthcare providers, and manufacturers to ensure seamless coordination of CGT treatments.

• Education: Provide education and training to pharmacy staff on payor requirements and best practices for managing authorizations and claims, as needed.

• Leadership. Ability to make decisions and lead in a startup-like environment, working collaboratively with a small team, and cross-functionally, to effectively grow a new business unit.

• Quality and Compliance: Maintain the highest standards of quality and compliance in all pharmacy operations, ensuring patient safety and product integrity.

• Patient-Centric Care: Foster a patient-centric approach to care, prioritizing patient experience and outcomes through high-touch, personalized services.

• Innovation and
  
  Collaboration:
  
  Drive innovation and collaboration across the ATS team and with external partners to continuously improve service offerings and patient care.

• Ideally targeting individuals with experience working at a specialty pharmacy, well versed in payor contracting (have led or owned contract negotiation processes for cell & gene therapies, either at a health system or payor) highly preferred.

• Experience with prior authorization approvals and medical/pharmacy benefit billing & coding, both highly preferred.

• Excellent verbal and written communication (to effectively negotiate with different health care stakeholder types).

• Strong time management to enable prompt follow up to any payor or health system communications.

• Strong relationship building and stakeholder management.

• Demonstrated ability to think strategically and make sound recommendations.

• Applies comprehensive knowledge and a thorough understanding of concepts, principles, and technical capabilities to perform varied tasks and projects.

• May contribute to the development of policies and procedures.

• Works on complex projects of large scope.

• Completes work independently and receives general guidance on new assignments.

• Work reviewed for purpose of meeting objectives.

$87,700.00 - $ USD

Bonus Eligible - Yes

• Medical, dental and vision coverage

• Paid time off plan

• Health…