Role Description
The Reimbursement Liaison will serve as an expert in reimbursement policies, as well as patient and provider support, to ensure patients have access to Glaukos’ sight saving technologies. The Reimbursement Liaison works with physician practices (both private and hospital affiliated institutions) and interacts directly with key management personnel, providers, and staff members to assure patient access to care.
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Educates HCPs and their office staff on clinical documentation, securing treatment approvals, patient tracking, claim submission, reconciliation management, patient education, drug inventory, patient copay assistance, and drug acquisition channels.
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Helps HCPs understand barriers that may impede or delay appropriate patient access to treatment and/or prevent optimal patient outcomes.
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Provides education on appropriate and accurate billing and coding practices for Glaukos’ products in line with payer requirements.
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Must be organized and detail-oriented with demonstrated teamwork and collaboration abilities.
Qualifications
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Bachelors Degree in related field; MBA or MPH preferred.
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8 plus years of experience working with specialty pharmaceuticals or surgical devices required.
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Minimum of 3 years “direct” reimbursement/healthcare policy experience required.
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Previous sales, district management, field reimbursement, hospital or practice experience preferred.
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Eyecare experience preferred.
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Reimbursement experience with physician-administered injectables and/or medical devices, Category III CPT codes and/or miscellaneous J-codes.
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Payer/insurance coverage experience with Medicare, Medicare Advantage, VA/Tri-Care, Commercial and Medicaid plans.
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Ability to travel adequately to cover territory, as well as overnight travel (~50%) and attendance at scheduled training and meetings.
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Proven record of accomplishment in achieving objectives and corporate goals with minimal direct supervision.
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Demonstrated creativity, situation analysis/problem solving skills, and analytical skill ability.
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Excellent communication skills, including written, verbal, and listening; strong presentation and training skills.
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Demonstrated leadership and project management skills.
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Significant experience working with a Patient Service Center/Hub.
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Successful navigation of complex authorization processes for specialty medications, Orphan, or Rare disease.
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Educate Healthcare Professionals on the availability of patient support programs such as Co-Pay Assistance and Patient Assistance Programs.
Requirements
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Responds to HCP questions related to coding, payer policy, and approval protocols.
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Offers expertise on navigating copay assistance for appropriate patients enrolled in GPS.
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Provides education on navigating the appeals process as well as denied and partially paid claims.
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Takes lead in completing Business Reviews and Claims Reviews for practices.
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Provides education on specialty pharmacy and buy & bill acquisition options.
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Monitors reimbursement trends and engages payer team appropriately when patient access may be jeopardized.
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Maintains expertise in regional and national payer landscapes, specifically, proper clinical requirements, reimbursement policy, utilization management criteria, prior authorization processes, and appeal requirements.
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Updates customers on policy changes through approved templates and plan approval.
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Identifies coverage gaps and computer errors on policy requirements or portal entry challenges that inhibit patient access to care.
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Manages all forms of communication in a timely and professional fashion to ensure customer needs are fully met and all relevant internal stakeholders are appropriately updated.
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Demonstrates positive leadership, without authority, to peers, upper management, and other stakeholders by leveraging skills and expertise in account management.
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Successfully completes assigned training.
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Consistently demonstrates uncompromised ethics and integrity while helping others understand legal and regulatory parameters related to anti-kickback statutes, fraud and abuse, off-label promotion, and OIG guidance related to patient assistance programs.
Benefits
