GLAUKOS – REIMBURSEMENT LIAISON (GLAUCOMA) - SOUTHERN CALIFORNIA
"We'll Go First" (https://youtu.be/wGONQxyEpvs [https://youtu.be/wGONQxyEpvs])
How will you make an impact?
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). They interact directly with key management
personnel, providers and staff members to assure patient access to care. This
individual appropriately 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. This position helps HCPs understand
barriers that may impede or delay appropriate patient access to treatment and/or
prevent optimal patient outcomes. Additionally, the Reimbursement Liaison
provides education on appropriate and accurate billing and coding practices for
Glaukos’ products in line with payer requirements to the highest levels of
specificity.
This candidate must be organized and detail oriented. Demonstrated teamwork and
collaboration abilities with high emotional intelligence in managing multiple
business initiatives and cross-functional relationships will be a requirement.
What will you do?
Specific responsibilities include but are not limited to:
Provides HCPs and their office staff education on how to interpret benefit
verifications including PA requirements, calculation of patient cost share
and drug acquisition options for specific patients enrolled in GPS.
Collaborates with Patient Support Specialist (PSS) to identify and eliminate
barriers to access for patients enrolled in GPS.
Responds to HCP questions related to coding, payer policy, and approval
protocols.
Offers expertise on navigating copay assistance for appropriate patients
enrolled in GPS.
Provides education on navigating the appeals process as well as denied and
partially paid claims.
Takes lead in completing Business Reviews and Claims Reviews for practices.
Provides education on specialty pharmacy and buy & bill acquisition options.
Monitors reimbursement trends (e.g., HCPs receiving notification of policy
changes, claim denials, underpayments, etc.) and engages payer team
appropriately when patient access may be jeopardized.
Maintains expertise in regional and national payer landscapes, specifically,
proper clinical requirements, reimbursement policy, utilization management
criteria, prior authorization processes and appeal requirements.
Updates customers on policy changes through approved templates and plan
approval.
Identifies coverage gaps and computer errors on policy requirements or portal
entry challenges that inhibit patient access to care.
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.
Demonstrates positive leadership, without authority, to peers, upper
management and other stakeholders by leveraging skills and expertise in
account management.
Successfully completes assigned training.
The Reimbursement Liaison 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.
How will you get here?
Bachelors Degree in related field. MBA or MPH preferred.
8 years of experience working with specialty pharmaceuticals or surgical
devices required.
Minimum of 3 years “direct” reimbursement/healthcare policy experience
required.
Previous sales, district management, field reimbursement, hospital or
practice experience preferred.
Eyecare experience preferred.
Reimbursement experience with physician-administered injectables and/or
medical devices, Category III CPT codes and/or miscellaneous J-codes,
specialty pharmacy and buy & bill acquisition, and benefit verifications,
prior authorizations, claims assistance, and appeals.
Payer/insurance coverage experience with Medicare, Medicare Advantage,
VA/Tri-Care, Commercial and Medicaid plans.
Ability to travel adequately to cover territory, as well as overnight travel
(~50%) and attendance at scheduled training and meetings.
Proven record of accomplishment in achieving objectives and corporate goals
with minimal direct supervision.
Demonstrated creativity, situation analysis/problem solving skills and
analytical skill ability.
Excellent communication skills, including written, verbal and listening.
Strong presentation and training skills.
Demonstrated leadership and project management skills.
Significant experience working with a Patient Service Center/Hub.
Successful navigation of complex authorization processes for specialty
medications, Orphan, or Rare disease.
Educate Healthcare Professionals on the availability of patient support
programs such as Co-Pay Assistance and Patient Assistance Programs.
#GKOSUS
#LI-Remote
Generous. Innovative. Leadership-driven. Family-oriented. Socially responsible.
Founded in 1998, Glaukos Corporation is an ophthalmic pharmaceutical and medical
technology company focused on developing and commercializing novel therapies for
the treatment of glaucoma, corneal disorders, and retinal diseases.
Our mission at Glaukos is to truly transform vision by pioneering novel,
dropless therapies that can meaningfully advance the standard of care and
improve the lives of patients suffering from chronic, sight-threatening eye
diseases.
Innovation is at the core of everything we do, and we are resolute in our
commitment to challenge conventional thinking with new treatment alternatives
that are supported by real science, robust clinical evidence, and an unrelenting
focus on patients.
Our constant pursuit of game-changing technologies that disrupt legacy treatment
paradigms is encapsulated in the Glaukos mantra “We’ll Go First,” which
articulates our willingness to take chances, our determination to forge new
ground, and our commitment to continuous improvement in all that we do.
Our company completed an initial public offering in June of 2015, and our shares
are traded on the New York Stock Exchange under the ticker symbol “GKOS”. Our
global headquarters is in Aliso Viejo, California with additional locations in
San Clemente, California, and Burlington, Massachusetts.
Glaukos Corporation is an Equal Opportunity/Affirmative Action Employer. All
qualified applicants will receive consideration for employment without regard to
race, color, religion, sex including sexual orientation and gender identity,
national origin, disability, protected Veteran Status, or any other
characteristic protected by applicable federal, state, or local law.
All offers of employment are contingent upon the successful completion of a
background check, including successfully passing a drug screen, based on the
position and local regulations.