National Accounts Director; Payor Accounts

Bausch + Lomb; Santa Fe (NM); On-site; USD 220,000 - 255,000; Full time

Benefits offered by this job

Health insurance

401(k) plan with company match

Tuition reimbursement (select degrees)

Paid time off / vacation schedule

Sick time and floating holidays

Well-being programs

Job summary

Bausch + Lomb, a leading eye health company, seeks a Director of Payor Account Management to lead national and regional payor strategies for the Elios System. You will manage a team of Regional Account Executives, align with sales, marketing and medical affairs to maximize patient access and revenue.

You will collaborate with HTAs, payors and KOLs to shape coverage, reimbursement, and policy through HEOR data, BIM, and clinical literature, with an emphasis on Medicare, private payors, and

Qualifications

• Bachelor’s degree in public health, life science or related field; ophthalmology experience preferred.
• 5–7 years of payor relations experience at Medicare and Private Insurance with strong CPT coding knowledge.
• Proven track record securing payor coverage for medical devices and emerging technologies.
• Strong ability to communicate clinical and economic data, coding and payment issues.

Responsibilities

• Lead national and regional payor coverage and reimbursement strategies to secure coverage and appropriate reimbursement.
• Engage with HTAs to review ELT and Elios System data and support literature.
• Build relationships with payors, understand medical policy, utilization review, PMPM thresholds, and claims processing.
• Collaborate with State Ophthalmology Advisory Committee members and payor Medical Directors to reflect local practices.
• Communicate value propositions using literature and BIM to influence coverage policy.
• Monitor Medicare and Commercial policies; analyze medical review and payment trends to guide strategy.
• Support Field Sales with key accounts on coverage, coding and payment requirements.
• Coordinate with Medical Affairs for clinical education with local KOLs to influence payor coverage.

Skills

Payor relations

Medicare knowledge

CPT coding

Medical device reimbursement

Leadership

Communication

Presentation skills

Education

Bachelor’s degree in public health or life sciences

Ophthalmology experience preferred

Tools

PowerPoint

Excel

Word

Job description

Bausch + Lomb (NYSE/TSX: BLCO) is a leading global eye health company dedicated to protecting and enhancing the gift of sight for millions of people around the worldfrom the moment of birth through every phase of life. Our mission is simple, yet powerful: helping you see better, to live better.

Our comprehensive portfolio of over 400 products is fully integrated and built to serve our customers across the full spectrum of their eye health needs throughout their lives. Our iconic brand is built on the deep trust and loyalty of our customers established over our 170-year history. We have a significant global research, development, manufacturing and commercial footprint of approximately 13,000 employees and a presence in approximately 100 countries, extending our reach to billions of potential customers across the globe. We have long been associated with many of the most significant advances in eye health, and we believe we are well positioned to continue leading the advancement of eye health in the future.

Job Description

The Director, Payor Account Management reports to the Head, Global Market Access, Surgical Glaucoma and is responsible for developing and managing strategic relationships with national and regional health plans and other third-party payors. This role will lead a team of Regional Account Executives (RAEs) to ensure that the Elios System will be positioned appropriately with payors, integrated delivery networks, and key hospitals to maximize patient access and organizational revenue. The Director will also partner cross-functionally with members of the sales, marketing, and medical / clinical affairs teams to inform the health economic outcomes research (HEOR) strategy required to obtain and maintain optimal coverage and reimbursement in the U.S.

• Key Responsibilities Lead the development and execution of National and Regional payor coverage and reimbursement strategies to ensure key clinical, HEOR data and overall value propositions result in payor coverage and appropriate reimbursement, commercial viability, and unfettered patient access to the Elios System.

• Engage with health technology assessment firms (HTAs) to provide up-to-date reviews of excimer laser trabeculostomy (ELT) and Elios System clinical data and provide education and materials in support of positive conclusions from peer reviewed clinical literature.

• Develop and maintain strong relationships with target payors and build a working knowledge of their key processes including medical policy, utilization review, PMPM thresholds, health outcomes, risk management, provider contracting, and claims processing.

• Develop relationships with State level Ophthalmology Advisory Committee members and payor Medical Directors for public and private payors to support changes that reflect local medical practices.

• Effectively leverage and communicate PRC approved payor presentation inclusive of published literature to payors, budget impact model (BIM) demonstrating Elios Systems value that positively influences coverage policy development.

• Monitor Medicare FFS, Medicare Advantage, Commercial payor coverage policies, track review periods, and analyze data on medical review, prior authorization, and claims payment trends to inform payor strategy, tactics, and team priorities.

• Collaborate with Field Sales Managers as needed with key accounts to ensure coverage, coding and payment requirements are understood to optimize pull through efforts.

• Work with Medical Affairs to support Clinical Education with key local KOLs to influence payor coverage and medical review policies.

• Improve effectiveness and focus of industry alliances, e.g. MDMA, OOSS, etc. as needed to support Medicare and commercial payor policy and patient access.

• Provide internal and external voice-of-customer (VOC) feedback to guide strategy development.

• Assist Head of Market Access with ensuring MACs provide appropriate coverage and payment for ELIOS (MPFS, ASC, HOPD)

• Assist in development of market access programs to train Sales Representatives

Qualifications

• Bachelors degree in public health, life science, graduate degree and ophthalmology experience preferred.

• 5-7 years of payor relations experience at Medicare and Private Insurance, eg. National and/or Regional level, strong knowledge of medical device reimbursement, CPT coding. Proven track record in securing positive payor coverage and reimbursement with medical devices.

• Demonstrated success in securing coverage for new and emerging technologies and influencing payor coverage policies.

• Strong understanding and ability to communicate clinical and economic data, coding, coverage, and payment issues.

• Comprehensive understanding of the current and evolving payor ophthalmology management landscape, i.e. MIGS and cataract perspective.

• Exceptional customer business planning, tactical planning, working with ambiguity and successful execution skills.

• Strong leadership, communication, and collaboration skills and the ability to drive consensus

• Strong understanding and acumen in reimbursement principles across multiple sites of care, i.e. physician offices, ambulatory surgery centers, hospital outpatient department.

• Strong written and presentation skills to executive management (internal and external).

• Proficient in Microsoft PowerPoint, Excel, and Word.

• Ability to travel 25 50%

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

For U.S. locations that require disclosure of compensation, the starting pay for this role is between $220,000.00 and $255,000.00. The estimated salary range reflects an anticipated range for this position. The actual base salary offered may depend on a variety of factors.

U.S. based employees may be eligible for short-term and/or long-term incentives. They may also be eligible to participate in medical, dental, vision insurance, disability and life insurance, a 401(k) plan and company match, a tuition reimbursement program (select degrees), company holidays, and well-being benefits, among others. U.S. based employees are also eligible to receive sick time, floating holidays and paid vacation.

Our US Benefit Programs Employee Benefits: Bausch + Lomb

Applicants must be authorized to work for ANY employer in the U.S. We are unable to sponsor or take over sponsorship of an employment Visa at this time.