Maximiliano Rizzo
Methuen,MA
Summary
Strategic Reimbursement and Patient Access leader with 10+ years of experience supporting specialty, rare disease, infusion, and injectable therapies across payer, provider, and manufacturer environments. Expertise in Medicare Parts A, B, C, and D, prior authorizations, appeals, coding and billing education, buy-and-bill reimbursement, specialty pharmacy distribution, site-of-care strategy, and payer policy navigation. Proven success partnering with with cross functional teams to resolve complex access barriers, accelerate access to-therapy, and optimize reimbursement outcomes. Recognized for maintaining compliant reimbursement support aligned with healthcare regulations and privacy standards.
Overview
1
1
Certification
10
10
years of professional experience
Work History
Access & Reimbursement Manager
Kyowa Kirin
05.2023 - Current
- Managed reimbursement processes to ensure timely and accurate claims submissions.
- Serve as the reimbursement and market access subject matter expert supporting rare disease and specialty biologic therapies across endocrinology and nephrology provider offices, infusion centers, and healthcare systems.
- Partner with nephrologists and endocrinologists to navigate complex access challenges associated with chronic metabolic and renal-related disorders requiring specialty injectable therapies.
- Educate healthcare providers, infusion staff, and practice administrators on payer policy requirements, coding and billing processes, specialty pharmacy distribution, and buy-and-bill reimbursement pathways for specialty biologics and injectable therapies.
- Drive prior authorization strategy, appeals, and coverage determination support across Medicare, Medicaid, and commercial payers, contributing to a 95% patient conversion and therapy initiation rate.
- Collaborate with specialty pharmacies, hub operations, field teams, market access, patient services, and clinical stakeholders to resolve complex reimbursement barriers and accelerate patient access to therapy.
- Support patients diagnosed with X-Linked Hypophosphatemia (XLH) and Tumor-Induced Osteomalacia (TIO), navigating complex coverage requirements across commercial, Medicare, and Medicaid plans.
- Monitor and communicate payer trends, policy updates, coding changes, and reimbursement challenges impacting patient access and provider operations.
- Maintain accurate Salesforce CRM documentation, complete compliance and pharmacovigilance reporting requirements, and ensure prompt adherence to HIPAA and healthcare regulatory standards.
Ultracare Liason
Ultragenyx
01.2019 - 04.2023
- Cultivate relationships with existing external partners, Field Sales, Field Reimbursement and Advocates.
- Help patient navigate the insurance landscapes by providing best in class service.
- Provide support individual patients through personalized, high touch service and addressing any reimbursement barriers to access therapy to our patients regarding Ultragenyx resources.
- Maintains comprehensive understanding of the reimbursement process.
- Provided training to new UCG's regarding Sales Force and all understanding of titles day to day operations.
- Conduct benefit investigations and secure insurance approval for therapy, proactively plans for maintenance of coverage by working with the patients/families, healthcare providers, insurance companies and specialty pharmacies.
- Leverages CRM reporting tools and data analytics to make strategic decisions about their territory and prioritize patient and customer needs.
- Engage patients/families to create a trusting relationship, uncover patient needs, understand challenges, and provide education and support.
- Manage complex issues and utilize approved resources to reduce/remove barriers as needed.
- Document call details with attention to data integrity to ensure compliance and enhance our service offering
Patient Service Manager
Shire Pharmaceuticals
05.2016 - 01.2019
- Communicated with patients with compassion while keeping medical information private.
- Update system to track progress.
- Collaborated with multi-disciplinary staff to improve overall patient care and response times.
- Cultivate relationship with external partners, field sales team, Reimbursement.
- Help navigate the insurance landscape.
- Provide support individual patients through personalized, high touch service and addressing any reimbursement barriers to access therapy to our patients.
Education
Bachelor of Arts - Psychology
University of Massachusetts, Lowell
Lowell, MA06-2000
MBA - Business Administration And Management
Emmanuel Collage
Boston, MA06-2022
Certification
- Prior Authorization Certified Specialist(PACS)
- What is Generative AI
- License Social Worker (LSWA)
Languages
Spanish
Native or Bilingual
Timeline
Access & Reimbursement Manager
Kyowa Kirin
05.2023 - Current
Ultracare Liason
Ultragenyx
01.2019 - 04.2023
Patient Service Manager
Shire Pharmaceuticals
05.2016 - 01.2019
MBA - Business Administration And Management
Emmanuel Collage
Bachelor of Arts - Psychology
University of Massachusetts, Lowell