Director Hub Services

Job description:

Summary of Position

The Director Hub Services is a senior individual contributor and operational leader responsible for overseeing the company's fully operational patient and provider services hub within the Medicare Part B radiopharmaceutical therapy (RLT) space. This role owns hub vendor governance, performance management, patient financial assistance programs, reimbursement case management infrastructure, and the operational systems that support provider and patient access — while the clinical and site-level benefits investigation and prior authorization work is owned and executed by the Field Reimbursement Manager (FRM) team.

This position is designed to evolve. As the Market Access function grows in scope and complexity, the Director, Hub Services will take on additional responsibilities in support of the broader market access strategy including reimbursement policy monitoring, payer coverage intelligence, field team enablement, and account-level access resolution. The role reports to the Senior Director, Market Access and operates with a high degree of autonomy and cross-functional accountability.

Essential Functions

Hub Operations Oversight

• Own day-to-day governance of the hub vendor, including performance against SLAs, case quality standards, call center metrics, and escalation protocols
• Monitor hub case volume, resolution rates, and turnaround times across patient financial assistance, reimbursement support, and provider inquiry case types
• Lead weekly business reviews at launch and monthly thereafter.
• Ensure hub processes are current with payer policy changes, HCPCS code updates, and site-of-care billing requirements specific to RLT and Part B radiopharmaceuticals
• Maintain the hub playbook and standard operating procedures; own all updates in response to reimbursement policy changes or product-level changes (e.g., new HCPCS code, OPPS status change, WAC adjustment)
• Serve as the primary internal escalation point for hub performance issues, vendor relationship management, and systemic access barriers surfaced through the hub

Patient Financial Assistance and Access Programs

• Govern the patient financial assistance program including co-pay support, PAP, and ensure program parameters are current and compliant
• Monitor patient co-pay program; collaborate with Market Access leadership on program adjustments in response to reimbursement shifts
• Ensure hub staff are trained on patient financial assistance eligibility criteria, program enrollment, and documentation requirements
• Partner with Legal and Compliance on patient assistance program design, OIG compliance, and annual program review
• Track and report on patient financial assistance program utilization, approval rates, and patient cost-sharing trends; surface insights to Market Access leadership

Reimbursement Infrastructure and FRM Enablement

• Develop and maintain provider-facing reimbursement resources including billing guides, HCPCS quick reference materials, site-of-care billing FAQs, and claim appeal templates for use by the FRM team in the field
• Partner with the FRM Lead and individual FRMs to triage and resolve complex or systemic site-level reimbursement issues escalated from the field; serve as the hub-to-field liaison for cases requiring hub intervention
• Ensure the hub vendor is equipped and trained to support FRM-escalated cases accurately and within agreed timelines
• Monitor operative reimbursement models (WAC 3%, MUC transitions, OPPS pass-through mechanics) and ensure hub staff and FRM-facing materials reflect current payment methodology at all times
• Identify reimbursement process gaps through FRM feedback and hub case data; design and implement solutions in partnership with the FRM Lead

Market Access: Evolving Scope

• As the Market Access function grows, this role will expand to include one or more of the following responsibilities based on organizational need and the incumbent's expertise:
• Reimbursement policy monitoring and CMS regulatory tracking of OPPS final rules, MUC methodology updates, HCPCS coding cycle, IRA inflation rebate implications, and diagnostic radiopharmaceutical payment rule changes
• Payer coverage intelligence to include systematic monitoring of Medicare Advantage plan policy updates, commercial payer formulary decisions, and step-therapy or prior authorization trends affecting RLT access
• National account reimbursement support and partnering with Access Director on site-level access barriers at IDN and health system accounts where hub infrastructure can provide leverage
• FRM team training and enablement including onboarding curriculum development, territory-level reimbursement intelligence briefings, and reimbursement tool creation
• Launch readiness for pipeline products or new indications including hub operational build-out, provider reimbursement playbook development, and patient access program design
• GPO and payer contracting support providing market access intelligence and reimbursement impact analysis to inform contracting decisions with ION, Onmark, Unity, and commercial payers
• Pricing and contracting development at the IDN/Health system level
• Price modeling for WAC changes and pipeline products
• State and government reporting of pricing and WAC changes
• Must maintain operational compliance with US and international regulatory agencies and guidelines (i.e. FDA, EU, HC, TGA, PIC/S, ISO, USP, NRC, cGMP, etc.)

Requirements

• Bachelor's degree in a health sciences, business, or related field; advanced degree (MBA, MHA, MPH, PharmD) preferred
• 12 or more years of progressive experience in pharmaceutical or biotech market access, with at least 5 years in hub services, patient services, or reimbursement operations in a Medicare Part B product setting
• Direct experience with buy-and-bill reimbursement mechanics, HCPCS coding, and the OPPS payment framework
• Demonstrated experience managing a hub vendor or patient services operation including governance, escalation management, and operational performance improvement
• Working knowledge of Medicare Part B coverage policy, Medicare Advantage plan dynamics, and commercial payer behavior in specialty oncology or radiopharmaceuticals
• Experience with patient financial assistance program design, OIG compliance, and patient out-of-pocket monitoring in a high-cost specialty product setting
• Experience with 340B program compliance considerations in a hub services or market access context
• Proven ability to evaluate hub operational data into strategic access insights and present findings to senior leadership
• Strong cross-functional collaboration skills; demonstrated ability to work effectively with FRM teams, Medical Affairs, Legal/Compliance, Account Directors, and commercial leadership

Preferred

• Experience in the radiopharmaceutical, nuclear medicine, or RLT space including familiarity with theranostics center operations, imaging, and PRRT treatment protocols
• Experience managing hub operations at or following a product launch in the Part B setting
• Familiarity with the OPPS pass-through payment designation process and MUC-based reimbursement transitions under the CY2025/2026 OPPS diagnostic radiopharmaceutical payment rules
• Experience developing reimbursement tools and educational materials for FRM teams or field-facing functions
• Knowledge of GPO contracting dynamics (ION, Onmark, Unity) and their interaction with hub services for community oncology accounts
• Experience with payer coverage monitoring and CMS regulatory tracking in an oncology or specialty radiopharmaceutical market access context

Working Conditions:

• Willingness to work in a team based environment.
• Close attention to detail required.
• May be required to sit or stand for long periods of time while performing duties.
• Travel of up to 30% may be required for hub vendor site visits, national sales meetings, payer summits, and cross-functional planning sessions.
• Must be able to work outside of regular work hours, including off shift, weekend, and holiday work as business needs require.