Access Operations Manager

COMPANY:

At BioCryst, we share a deep commitment to improving the lives of people living with complement-mediated and other rare diseases. For over three decades we’ve been guided by our passion for not settling for “ordinary” in our quest to develop novel medicines. We leverage our expertise in structure-guided drug design to develop first-in-class or best-in-class oral small-molecule and protein therapeutics, led by the efforts of our team of expert scientists in our Discovery Center of Excellence in Birmingham, Alabama. Our global headquarters is in Durham, North Carolina, our European headquarters is in Dublin, Ireland and our employees span the globe across sites in multiple countries. We are proud of our culture of engagement and accountability that rewards people for innovative thinking and achievement of key objectives. For more information, please visit our website at www.biocryst.com or follow us on LinkedIn and Instagram.

JOB SUMMARY:

The Access Operations Manager (AOM) will work as part of a team to develop a successful prior authorization strategy and will be responsible for evaluating and reviewing prior authorizations. The AOM will also support the day-to-day efforts of the patient services functional team. This role will collaborate and engage with internal stakeholders and Specialty Pharmacy partners.

ESSENTIAL DUTIES & RESPONSIBILITIES:

• Drive strategy to streamline the prior authorization process, optimize request submissions, efficiently handle denials and appeals
• Lead strategy to identify and minimize impact of alternative funding programs (AFPs)
• Direct and monitor the beginning-to-end process of receiving, researching, and resolving Prior Authorizations and Appeals, including any escalated step of the appeals process in accordance with federal regulatory requirements and policies and procedures.
• Analyze all necessary documents and materials for Prior Authorizations and Appeals to verify completeness, accuracy, relevance, and timeliness.
• Identify missing elements from in-market resources and support creation of new resources
• Ensure the correct forms and documentation specific to payer policy are used for each PA submission.
• Establish relationships and ways-of-working with Specialty Pharmacy partner.
• Stay informed about payer requirements, policy changes, and procedures.
• Attend relevant industry conferences to stay abreast of market changes and their impact
• Evolve institutional knowledge/expertise relating to patient access by memorializing key initiatives that enable us to overcome unique access barriers.
• Drive the development of information tools and resources to enable sustained execution of novel access initiatives identified as our expertise in this area continues to evolve
• Ensure prior authorizations and appeals cases follow current CMS guidelines and timeliness criteria.
• Accountable for the overall management and delivery of standard documents such as Work Instructions and Standard Operating Procedures with emphasis on accuracy, consistency, and Quality Assurance.
• Oversee daily monitoring of patient status changes within BioCryst Central and follow-up with internal stakeholders and the specialty pharmacy
• Provide operational insight to various internal stakeholders with regards to specialty pharmacy data
• Identify process improvement opportunities within Patient Services
• Lead day-to-day operations and support broad operational needs of the patient services function.
• Ensure Patient Support Program business rules and adhere to all safety, legal, and regulatory requirements.
• Oversee quality-control efforts relating to Pharmacy interface with payers for consented patients.
• Lead cross-functional Access Trends Committee.
• Develop and facilitate training programs for contracted partners and vendors.
• Review technical denial arguments for reconsideration.
• Develop KPIs to lead performance improvement efforts. In partnership with Specialty Pharmacy Partners, monitor TAT/SLAs specific to PAs and Appeals.
• Create and maintain KPI dashboards
• Leverage internal reports and external websites to identify and assess trends around payer responses including processes and outcomes and escalate as appropriate.
• Other duties as assigned.

EXPERIENCE & QUALIFICATIONS:

• Bachelor's degree in related field or equivalent combination of education and experience
• 8+ years’ relevant commercial experience in pharmacy and prescription benefits with a keen understanding of patient access stakeholders, including payers and healthcare providers.
• Relevant experience in rare disease or specialty product markets required.
• Relevant experience in Specialty Pharmacy and/or biotech/pharma preferred.
• Deep understanding of commercial, private, and government/public payers such as Medicaid and Medicare.
• Expertise in Prior Authorizations and Appeals.
• Proven experience in project management, quality assurance, and quality systems implementation preferred.
• Strong problem-solving skills with the ability to think critically and make sound decisions based on data analysis.
• Excellent written and verbal communication skills.
• Creative thinker with the ability to generate new ideas.
• Ability to work independently, with limited supervision.
• Understand the impact of the regulatory requirements on departmental procedures (id: CMN, state and federal requirements, etc.
• Effective interpersonal skills and customer service focus; ability to effectively and professionally interact with individuals at all levels of the organization as well as external parties.
• Energetic and forward thinking with high ethical standards.
• Ability to work effectively in a collaborative, open environment.
• Excellent oral and written communication skills.
• Demonstrated basic computer skills, specifically with Microsoft Word, Excel, PowerPoint, and Outlook.
• Ability to determine appropriate level of escalation and mitigation for identified risks.

The statements in this position description are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of responsibilities, duties, and skills required of personnel so classified. The manager may assign additional responsibilities and assignments from time to time.

BioCryst is an equal opportunity employer and is committed to providing equal employment opportunities without regard to age, race, religion, sex, sexual orientation, gender identity, national origin, Veterans status, disability and/or other protected class characteristics. Additionally, BioCryst is committed to achieving its business objectives in compliance with all federal, state and local law.