Cornea Reimbursement Liaison - Boston, MA | Augusta, ME | Burlington, VT | Hartford, CT | Manch[...]

GLAUKOS – REIMBURSEMENT LIAISON (CORNEA)

Reimbursement Liaison will serve as an expert in reimbursement policies, patient and provider support, to ensure patients have access to Glaukos’ sight‑saving technologies. 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. 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? Provide 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. Collaborate with Patient Support Specialist (PSS) to identify and eliminate barriers to access for patients enrolled in GPS. Respond to HCP questions related to coding, payer policy, and approval protocols. Offer expertise on navigating copay assistance for appropriate patients enrolled in GPS. Provide 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. Provide education on specialty pharmacy and buy & bill acquisition options. Monitor reimbursement trends (e.g., HCPs receiving notification of policy changes, claim denials, underpayments, etc.) and engage payer team appropriately when patient access may be jeopardized. Maintain expertise in regional and national payer landscapes, specifically proper clinical requirements, reimbursement policy, utilization management criteria, prior authorization processes, and appeal requirements. Update customers on policy changes through approved templates and plan approval. Identify coverage gaps and computer errors on policy requirements or portal entry challenges that inhibit patient access to care. Manage all forms of communication in a timely and professional manner to ensure customer needs are fully met and all relevant internal stakeholders are appropriately updated. Demonstrate positive leadership, without authority, to peers, upper management and other stakeholders by leveraging skills and expertise in account management. Successfully complete 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? Bachelor’s Degree in a related field. MBA or MPH preferred. 8+ years of experience working with specialty pharmaceuticals or surgical devices required. Minimum of 3 years of 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. #J-18808-Ljbffr Glaukos Corporation