Glaucoma Access & Reimbursement Specialist (Remote)

Glaukos; Houston (TX); Remote; USD 120,000 - 150,000; Full time

Job summary

Glaukos is seeking a Reimbursement Liaison (GlaUcoma) to join our team in Houston. The role focuses on education for healthcare professionals on benefit verifications, payer policy, and patient support programs.

You will work with GPS to remove barriers to access, respond to coding questions, and lead reviews for practices. The ideal candidate has extensive reimbursement experience, strong communication and leadership skills, and is prepared for up to 50% travel.

Qualifications

• Bachelor's 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.

Responsibilities

• 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.

Skills

Communication skills

Leadership

Project management

Analytical skills

Travel readiness

Education

Bachelor's Degree in related field

MBA or MPH preferred

Job description

Glaukos is seeking a Reimbursement Liaison (GlaUcoma) to join our team in Houston. The role focuses on education for healthcare professionals on benefit verifications, payer policy, and patient support programs.

You will work with GPS to remove barriers to access, respond to coding questions, and lead reviews for practices. The ideal candidate has extensive reimbursement experience, strong communication and leadership skills, and is prepared for up to 50% travel.