Glaucoma Reimbursement Liaison

Glaukos Corporation•San Clemente, CA

10d•Remote

About The Position

The Reimbursement Liaison serves as an expert in reimbursement policies and patient and provider support, helping ensure patients can access Glaukos’ sight-saving technologies. The role works with private and hospital-affiliated physician practices and interacts with management personnel, providers, and staff to support access to care. The liaison educates healthcare professionals and office staff on clinical documentation, treatment approvals, patient tracking, claim submission and reconciliation, patient education, drug inventory, copay assistance, and drug acquisition channels. The role also helps practices identify barriers that could delay treatment or affect patient outcomes, and provides guidance on accurate billing and coding in accordance with payer requirements. The position requires organization, attention to detail, teamwork, collaboration, emotional intelligence, and the ability to manage multiple initiatives and cross-functional relationships. The liaison monitors reimbursement trends and payer requirements, supports practice and claims reviews, communicates policy changes, and works with internal teams to address coverage gaps and access barriers. The role must consistently demonstrate ethics and integrity while helping others understand legal and regulatory requirements related to patient assistance and healthcare practices. The role is based in Atlanta, Georgia, and requires sufficient travel to cover the territory, including approximately 50% overnight travel and attendance at scheduled training and meetings. The posting also includes the designation “#LI-Remote.”

Requirements

Bachelor’s degree in a related field.
Eight years of experience working with specialty pharmaceuticals or surgical devices.
At least three years of direct reimbursement or healthcare policy experience.
Experience with reimbursement for physician-administered injectables and/or medical devices, Category III CPT codes and/or miscellaneous J-codes, specialty pharmacy and buy-and-bill acquisition, benefit verifications, prior authorizations, claims assistance, and appeals.
Payer or insurance coverage experience with Medicare, Medicare Advantage, VA/Tri-Care, commercial, and Medicaid plans.
Ability to travel adequately to cover the territory and undertake approximately 50% overnight travel, as well as attend scheduled training and meetings.
Demonstrated record of achieving objectives and corporate goals with minimal direct supervision.
Creativity, situation analysis, problem-solving, and analytical skills.
Excellent written, verbal, and listening communication skills.
Strong presentation and training skills.
Demonstrated leadership and project-management skills.
Significant experience working with a Patient Service Center or Hub.
Successful navigation of complex authorization processes for specialty medications, orphan diseases, or rare diseases.
Ability to educate healthcare professionals about patient support programs, including copay assistance and patient assistance programs.
Organization, attention to detail, teamwork, collaboration, and emotional intelligence for managing multiple initiatives and cross-functional relationships.
Uncompromised ethics and integrity when working within legal and regulatory requirements.

Nice To Haves

MBA or MPH.
Previous sales, district management, field reimbursement, hospital, or practice experience.
Eyecare experience.

Responsibilities

Educate healthcare professionals and office staff on benefit verifications, prior authorization requirements, patient cost-share calculations, and drug acquisition options for patients enrolled in GPS.
Collaborate with Patient Support Specialists to identify and eliminate access barriers for patients enrolled in GPS.
Respond to healthcare professional questions about coding, payer policy, and approval protocols.
Advise on copay assistance options for appropriate GPS patients.
Educate practices on appeals and on addressing denied or partially paid claims.
Lead business reviews and claims reviews for practices.
Educate practices on specialty pharmacy and buy-and-bill acquisition options.
Monitor reimbursement trends, including payer policy changes, claim denials, and underpayments, and engage the payer team when access may be jeopardized.
Maintain expertise in regional and national payer landscapes, including clinical requirements, reimbursement policy, utilization management criteria, prior authorization processes, and appeals requirements.
Communicate policy changes to customers using approved templates and plan approval.
Identify coverage gaps, computer errors in policy requirements, and portal-entry challenges that inhibit patient access.
Manage communications promptly and professionally, meeting customer needs and keeping relevant internal stakeholders informed.
Demonstrate positive leadership with peers, management, and stakeholders through account-management expertise.
Complete assigned training.
Help others understand legal and regulatory parameters related to anti-kickback statutes, fraud and abuse, off-label promotion, and OIG guidance concerning patient assistance programs.
Travel as needed to cover the territory, including overnight travel and attendance at scheduled training and meetings.