Director, Field Reimbursement - California
Glaukos is an ophthalmic medical technology company focused on the development and commercialization of breakthrough products and procedures designed to transform the treatment of glaucoma, one of the world's leading causes of blindness. We have pioneered Micro-Invasive Glaucoma Surgery, or MIGS, to revolutionize the traditional glaucoma treatment and management paradigm. We launched the iStent, our first MIGS device, in the United States in July 2012 and we are leveraging our platform technology to build a comprehensive and proprietary portfolio of micro-scale injectable therapies designed to address the complete range of glaucoma disease states and progression. We believe the iStent is the smallest medical device ever approved by the Food and Drug Administration, or FDA, measuring 1.0 mm long and 0.33 mm wide.
The Director, Field Reimbursement position is focused on providing internal and external customers with complete and accurate information on coding, coverage and payment, as well as obtaining coverage and adequate payment from regional payers/economic buyers for Glaukos devices. Additionally, this Director, Field Reimbursement will assist the US sales force in discussing practice economics, hospital economics, and provider reimbursement with key targeted customers. Duties include tactical activities in support of customers and field based sales personnel to support the adoption of Glaukos devices. Key functions to include coding and payment analysis, health technology assessment preparation, insurance authorization analysis, coverage analysis, cost effectiveness analysis, and building relationships with regional payers and targeted providers Creates awareness among key healthcare decision makers and payers to ensure a favorable government and private reimbursement environment, improving acceptance and increasing adoption of Glaukos devices and the procedures in which they are utilized.
Develop and implement a focused payer and managed care plan based on key local and regional government and commercial payers
- Identifies the managed health care opportunities and barriers to entry. Works with assigned payers and providers to establish or change coverage and payment policies.
- Develops and manages a network of payer reimbursement contacts and data to assist in the research and tactical implementation of the payer plan.
- Establishes strong relationships as the key contact with payers by fostering mutually beneficial long term benefits. Works with medical societies representing physician customers to achieve appropriate coding and payment.
Provide informational programs and collateral support materials to Glaukos customers to optimize product reimbursement.
- Delivers presentations to payers to establish and/or improve reimbursement coverage policies, coding and payment assignments utilizing available resources:
- Works with state and local professional societies as well as federal agencies to ensure patient access.
- Health Economics
- Comparative Effectiveness Data
- Key Opinion Leader Physicians
- Works with internal reimbursement team, and external reimbursement consultants as appropriate, to develop tools for customers focused on creating access for patients, through accurate and current coding information.
- Works with new and existing accounts to identify and coordinate education needs.
- Evaluates incoming requests from the field and ensures each request is properly evaluated for feasibility, technical risk, cost and time constraints, compliance and other relevant considerations.
- Distributes pre-authorization materials, accurate information to customers; tracks and reports on trends.
- Assists in addressing appeals for authorization and payment.
- Manages hotline, email and web inquiries on a timely basis.
- Promotes reimbursement support and represents the company to external customers by writing, phoning, visiting, hosting and participating in events.
- Remains aware of changing reimbursement environment by interacting with field contacts, attending professional seminars/conferences and reading industry journals and web news. Evaluates levels of customer support and improves them.
Provide informational programs and collateral support to Glaukos customers to support practice economics around Glaukos portfolio products
- Working with the regional business managers, provide customers with latest provider reimbursement and facility reimbursement education
- Works to educate targeted customers on practice economics when using Glaukos portfolio products
- Leads discussions with financial decision makers in hospitals, ASC, and physician groups on the economics of Glaukos portfolio products Develops materials to effectively communicate the economics of Glaukos portfolio products
Daily activities include:
- Works to solve situational reimbursement/coverage related issues as they arise.
- Provide accurate and current information to Glaukos customers to support field sales through management of reimbursement issues and programs, interpretation of policy and training of physicians, facilities and staff members in reimbursement and coding.
- Assist customers with achieving appropriate reimbursement and understanding reimbursement tactics for meeting payer requirements for documentation of medical necessity.
- Respond to coverage, coding, and payment inquiries from providers by offering objective information based upon qualified and recognized reimbursement sources that may assist the physician in making an informed coding determination based on the procedure to be performed with a Glaukos device.
- Track payer/provider trends by geography.
- Other duties as assigned.
Education: Bachelor (BA/BS) degree and 5+ years of experience in reimbursement and healthcare policy developmentWork Experience:8+ years of experience in reimbursement / healthcare policy developmentKnowledge, Skills and Abilities:Knowledge of managed care and health insurance industryExperience working with organizational decision makers – marketing, regulatory and sales managersExperience working directly with sales representativesAttention to detail
- Demonstrated knowledge and experience in payer (Medicare, Medicaid, and Private) policies, reimbursement process and the health care legislative environment
- Experience in interacting effectively with payer decision-makers, health care reimbursement professionals and local carrier medical directors
- Experience in using clinical data to support reimbursement position in presentations
- Knowledge of health care provider issues related to reimbursement and practice economics
- Experience working with reimbursement strategies and tactics
- Working knowledge of computer software including Word, Excel, PowerPoint and MS Project
- Project management skills
- Ability to travel to payer and prospective customer/customer sites
- Ability to follow and implement policies and procedures required of this position
- Detailed knowledge of insurance companies including government payers (Medicare, Medicaid, Tricare) and private payers (PPOs and HMOs) with regard to professional and facility payment systems
- Effective communication and presentation skills, strong telephone skills
- Well-organized, self-motivated
- Occasional weekend work commitment
We offer competitive salary (based on experience), bonus eligibility, medical/dental/vision, life insurance, stock options, 401(k) Employer Match, 3 weeks paid time off, 13 company paid holidays, Employee Stock Purchase Program and 2 additional paid days off to volunteer in our community, plus the opportunity to work for a company that is pioneering a new glaucoma treatment class. Check out our profile on The Muse to get an inside look at our company culture: https://www.themuse.com/companies/glaukoscorporation
Glaukos has been recognized by the Orange County Business Journal as one of the best companies to work for in in Orange County, check out page 8 at http://www.cbjonline.com/a1ocbj/lists/List-2017-OC_Best-Places-to-Work.pdf
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