Payer Relations Director

Glaukos Corporation • San Clemente, CA

1d • Remote

About The Position

The Payer Relations Director (PRD) is a remote, home-based position responsible for ensuring successful coverage and reimbursement, and managing the overall coverage, coding, and reimbursement processes within an assigned region. This includes commercial insurance, MACs, and Medicaid. The role involves establishing favorable payer coverage, ensuring fair payment, and removing reimbursement barriers. The PRD will also coordinate and execute reimbursement support for Key Opinion Leader (KOL) healthcare providers who influence payers and state societies within their geography to impact favorable coding, coverage, and access. This position partners with the Glaucoma Reimbursement Liaison Team and RL leadership to deliver consultations with KOL physicians and institutional customers, assisting with reimbursement barriers. The PRD interacts with medical directors, MAC medical policy staff, MAC case managers, CMS MAC medical directors and staff, state government health staffers, state societies and advocacy groups, KOL physicians, and hospital and ASC staff. They will act as an expert in payer policies, providing support to facilitate appropriate coverage, payment, patient access, and utilization of services. The PRD will foster collaboration with Sales, Customer Relations, Reimbursement Liaisons, and Medical Affairs teams to achieve strategic business goals and build relationships with key healthcare stakeholders to establish a foundation for coding, coverage, and payment for future technologies. Candidates must be organized, detail-oriented, and possess strong teamwork and emotional intelligence skills to manage multiple business initiatives and cross-functional relationships.

Requirements

• Bachelor's Degree required
• 15+ years of relevant industry experience
• At least 10 years of Payer medical devices and biologics experience, ideally with injectable buy and bill drugs.
• Direct biologic launch experience highly desirable.
• In-depth knowledge of the buy and bill system.
• Minimum 2 years of experience in: practice management, or practice billing and revenue cycle; experience with public or private third-party reimbursement related to product access impact on providers; or experience in pharmaceutical or managed care industry reimbursement including provider site reimbursement interactions.
• Knowledge of private payer, Medicare and Medicaid structure systems and reimbursement process.
• Technical knowledge of health care reimbursement from a patient and provider perspective (T codes, miscellaneous J codes, billing coding, appeals process).
• Knowledge of reimbursement policies and hotline database systems.
• Ability to travel overnight for 3-4 nights per week; 50+% travel.
• Strong communication skills; ability to effectively interact with all healthcare stakeholders.
• Ability to analyze and interpret regulation and legislation.
• In-depth knowledge and understanding of AdvaMed, MDMA. BIO and PHARMA Guidelines.
• Project management skills and the ability to work independently.

Nice To Haves

• Advanced degree or specific Practice Management experience
• Ophthalmology experience preferred.
• 10+ years of reimbursement and account management experience preferred.

Responsibilities

• Develop and execute strategies for targeted national and regional plans, as well as MAC/Medicaid, designed to secure coverage for newly-marketed products, maintain coverage for existing products, minimize barriers to access, solve reimbursement issues, and support sales for Glaukos marketed products.
• Work closely with Sales Leadership and field sales representatives to appropriately support KOL healthcare providers with their reimbursement needs.
• Develop sustainable corporate relationships that will allow for continued growth of current and future technologies.
• Understand and work with key health care stakeholders within Commercial Managed Care (Regional Plans), Medicare (Part A, B, C, D; Carriers), Medicaid (Fee for Service, Managed Care Organizations), State Government Health Staffers, Veteran's Administration (VISNs), TRICARE Regional Offices, Specialty Pharmacy & Pharmacy Benefit Managers, Medical Groups, and State Advocacy, patient, provider and other key healthcare stakeholder groups.
• Conduct required outreach and networking with state/local KOL provider, patient, and healthcare systems advocacy organizations.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior