Sr. Reimbursement Liaison - Field/Remote

<p class="">Here at Glaukos, we recognize the deep significance and profound meaning that comes from knowing that we can make a meaningful difference by helping improve the eyesight of people worldwide. Because we&rsquo;re a rapidly growing company with a dynamic, fast-paced culture, employees here are empowered with more diverse and enriching challenges than might not be possible at a larger company.</p> <strong>Base Salary Range: $125,500 - $181,900</strong>

Aliso Viejo, CA

Glaukos

<h4>Founded in 1998, Glaukos Corporation is an ophthalmic medical technology and pharmaceutical company focused on novel therapies for the treatment of glaucoma, corneal disorders, and retinal diseases.</h4> <h4>Our company was the first company to bring to market Micro-Invasive Glaucoma Surgery (MIGS), the micro-invasive procedure which revolutionized the treatment and management of glaucoma. In 2012, we launched our first MIGS device&mdash;the iStent&reg;&mdash;in the United States, followed by our next-generation iStent&nbsp;inject&reg;&nbsp;device in September 2018 and iStent&nbsp;inject&reg;&nbsp;W in September 2020.</h4> <h4>In November 2019, Glaukos acquired Avedro, maker of the first and only FDA-approved cross-linking technology for progressive keratoconus. And we continue to seek to leverage our platform technologies to build a comprehensive and proprietary portfolio of micro-scale surgical and pharmaceutical therapies for glaucoma, corneal health, and retinal diseases.</h4> https://www.glaukos.com/

keywords: position summary,compensation,compliance,performance,grow,teamwork,legal,operations,experience,education,insurance,skills,travel

Full time

Base Salary Range: $125,500 - $181,900

Overview: <p>The&nbsp;<strong>Patient Reimbursement Liaison</strong>&nbsp;team is part of Glaukos Patient Services (GPS), and will serve as experts in payer policies, patient, and provider support to facilitate appropriate patient access services to ensure patients have access to Glaukos&rsquo; sight saving technologies.</p> <p>The&nbsp;<strong>Patient Reimbursement Liaison&nbsp;</strong>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. The Patient Reimbursement Liaison 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. The Patient Reimbursement Liaison helps HCPs understand barriers that may impede or delay appropriate patient access to treatment and/or prevent optimal patient outcomes.&nbsp; Additionally, the Patient Reimbursement Liaison provides education on appropriate and accurate billing and coding practices for Glaukos&rsquo; products in line with payer requirements and to the highest levels of specificity. &nbsp;</p>
Responsibilities: <ul> <li>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.&nbsp;</li> <li>Collaborates with Patient Support Specialist (PSS) to identify and eliminate barriers to access for patients enrolled in GPS.&nbsp;</li> <li>Responds to HCP questions related to coding, payer policy, and approval protocols.&nbsp;</li> <li>Offers expertise on navigating copay assistance for appropriate patients enrolled in GPS.&nbsp;</li> <li>Provides education on navigating the appeals process as well as denied and partially paid claims, including specialty pharmacy and buy &amp; bill acquisition options.&nbsp;&nbsp;</li> <li>Takes lead in completing Business Reviews and Claims Reviews for practices.&nbsp;</li> <li>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.&nbsp;</li> <li>Maintains expertise in regional and national payer landscapes, specifically, proper clinical requirements, reimbursement policy, utilization management criteria, prior authorization processes and appeal requirements.&nbsp;</li> <li>Updates customers on policy changes through approved templates and plan approval.&nbsp;</li> <li>Identifies coverage gaps and computer errors on policy requirements or portal entry challenges that inhibit patient access to care.&nbsp;&nbsp;</li> <li>Ability to travel adequately to cover territory, as well as overnight travel (~50%) and attendance at scheduled training and meetings.&nbsp;</li> </ul>
Requirements: <ul> <li>Bachelor's Degree in related field.&nbsp;&nbsp;</li> <li>7+ years of experience working with specialty pharmaceuticals or devices and a minimum of 1 year in a patient access-related position.&nbsp;</li> <li>Reimbursement experience with physician-administered injectables and/or medical devices, Category III CPT codes and/or miscellaneous J-codes, specialty pharmacy and buy &amp; bill acquisition, and benefit verifications, prior authorizations, claims assistance, and appeals.&nbsp;</li> <li>Payer/insurance coverage experience with Medicare, Medicare Advantage,&nbsp;VA/Tri-Care, Commercial and Medicaid plans.&nbsp;</li> <li>Proven record of accomplishment in achieving objectives and corporate goals with minimal direct supervision and&nbsp;demonstrated creativity, situation analysis/problem solving skills and analytical skill&nbsp;ability.&nbsp;</li> <li>Significant experience working with a Patient Service Center/Hub.&nbsp;</li> <li>Successful navigation of complex authorization processes for specialty medications, Orphan, or&nbsp;Rare disease.&nbsp;</li> <li>Educate Healthcare Professionals on the availability of patient support programs such as Co-Pay Assistance and Patient Assistance Programs.&nbsp;</li> </ul> <br /><br /> <p>Preferred:&nbsp;&nbsp;</p> <ul> <li>MBA or MPH preferred.&nbsp;&nbsp;</li> <li>Previous sales, district management, field reimbursement, hospital or practice experience preferred.&nbsp;</li> <li>Eyecare experience preferred.&nbsp;</li> </ul>