The Payer Relations Director (PRD), is a remote, home based position and is
responsible for the successful coverage and reimbursement as well as the overall
management of coverage, coding, and reimbursement processes within an assigned
region encompassing commercial insurance, MAC(s), Medicaid. Successful
performance will include establishing favorable payer coverage, ensuring fair
and consistent payment, and removing barriers in the overall reimbursement
process. The position is also responsible for the coordination and execution of
reimbursement support for KOL healthcare providers that are influencers within
the assigned geography on payers, state societies to impact favorable coding,
coverage and access. The PRD partners with the Glacoma 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 a variety of customers to
include; 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, 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 their access to
care. The PRD will promote collaboration with the Sales, Customer Relations,
Reimbursement Liaisions, and Medical Affairs teams to achieve payer and provider
strategic business goals along with build the relationships and foundation with
key healthcare stakeholders to establish a foundation for coding, coverage and
payment for future technologies. This candidate must be organized and
detail-oriented. Demonstrated teamwork abilities with high emotional
intelligence in managing multiple business initiatives and cross-functional
relationships with key internal and external healthcare stakeholders will be a
requirement to achieve their goals.
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 relationship 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.
QUALIFICATIONS
- Bachelor's Degree required
- Advanced degree or specific Practice Management experience
- 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. Ophthalmology experience preferred.
- In depth knowledge of the buy and bill system.
- 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
- 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.
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.