Payer Relations Director

Glaukos•San Clemente, CA

1d•$173,400 - $216,800•Remote

About The Position

The Payer Relations Director (PRD) is a remote, home-based position responsible for successful coverage and reimbursement, as well as the overall management of coverage, coding, and reimbursement processes within an assigned region. This region encompasses commercial insurance, MAC(s), and Medicaid. Successful performance includes establishing favorable payer coverage, ensuring fair and consistent payment, and removing barriers in the reimbursement process. The position also involves coordinating and executing reimbursement support for Key Opinion Leader (KOL) healthcare providers who influence payers and state societies within the assigned geography to impact favorable coding, coverage, and access. The PRD partners with the Glaucoma Reimbursement Liaison Team and RL leadership team to deliver consultations with KOL physicians and institutional customers through specialized services to assist with reimbursement barriers. This position interacts with various customers including medical directors, MAC medical policy staff, MAC case managers, CMS MAC medical directors and staff, state government health staffers, state society and advocacy groups, KOL physicians, and hospital and ASC staff. They will serve as an expert in payer policies and provide support to facilitate appropriate coverage, payment, patient access, and utilization of services to ensure patient access to care. The PRD will promote collaboration with the Sales, Customer Relations, Reimbursement Liaisons, and Medical Affairs teams to achieve payer and provider strategic business goals, and build relationships and foundations with key healthcare stakeholders to establish a foundation for coding, coverage, and payment for future technologies. The candidate must be organized and detail-oriented, with demonstrated teamwork abilities and high emotional intelligence in managing multiple business initiatives and cross-functional relationships with key internal and external healthcare stakeholders.

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.
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.
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

Responsibilities

Develop and execute strategies for targeted national and regional plans, as well as MAC/Medicaid that is 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 the Sales Leadership and field sales representatives to appropriately support KOL health care 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 the following customers: 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, State Advocacy, patient, provider and other key healthcare stakeholder groups.
Required outreach and networking with state/local KOL provider, patient and healthcare systems advocacy organizations.