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Business Advisor, Reimbursement

4 months ago

Oklahoma City, Oklahoma, United States AbbVie Full time
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Featured Employers
Business Advisor, Reimbursement - BOTOX - OK, AR

Company:

Abbvie

Location:

Oklahoma City, OK

Employment Type:

Full Time

Date Posted:

05/26/2024
Job Categories:

Accounting/Auditing, Advertising/Marketing/Public Relations, Biotechnology and Pharmaceutical, Consulting Services, Finance/Economics, Healthcare, Other, Healthcare, Practitioner and Technician, Information Technology, Insurance, Internet/E-Commerce, Legal, Sales, Counseling, Broadcasting/Communications, Quality Control, Research & Development, Medical, Web Technology
Job Description
Business Advisor, Reimbursement - BOTOX - OK, AR
About AbbVie

AbbVie's mission is to discover and deliver innovative medicines that solve serious health issues today and address the medical challenges of tomorrow.

We strive to have a remarkable impact on people's lives across several key therapeutic areas:

immunology, oncology, neuroscience, eye care, virology, women's health and gastroenterology, in addition to products and services across its Allergan Aesthetics portfolio.

For more information about AbbVie, please visit us at . Follow @abbvie on Twitter , Facebook , Instagram , YouTube

and LinkedIn .

The Reimbursement Business Advisor (RBA) works with physician practices-both private and hospital institutions. They may interact directly with key management personnel, providers and staff members to assure patient access to care.

The RBA

works with providers and their practice personnel to enhance operational and reimbursement processes specific to the use of BOTOX

for all twelve approved indications.

The RBA appropriately educates the customer on all the fundamental elements of the BOTOX

treatment process.


These elements include patient identification, clinical documentation, securing treatment approvals, patient tracking, claim submission, reconciliation management, patient education, drug inventory, and drug acquisition channels.


The RBA helps customers understand barriers that may impede or delay appropriate patient access to treatment and/or prevent optimal patient outcomes.


The RBA provides education on appropriate and accurate billing and coding practices for BOTOX in line with payer requirements and to the highest levels of specificity.

The RBA demonstrates competence in the following areas:

Major medical benefits, pharmacy benefits, Buy & Bill, specialty pharmacy, injectables, payer policy, and different customer specialties.

The RBA works effectively and appropriately with stakeholders (RBA Director, Field Sales, Managed Markets, Account and Region Directors) in a heavily matrixed environment to achieve the targeted results.

The employee conducts all work activities in compliance with all Abbvie internal requirements and with all applicable regulatory requirements.

Physician and Office Support and Patient Management

Customer Service:

Responds to customer questions related to coding, payer policy and approval protocols, within 1-2 business days
Collaborates with the customer to identify the specific needs of the practice.

Offers approved tools and resources spanning reimbursement operations and other office processes integral to the appropriate use of BOTOX and consistent with Allergan's business priorities
Provides staff education on how to use the BOTOX ONE portal to assist with Benefit Verifications, Prior Authorization, Drug Acquisition and Patient Tracking and Management
Offers approved resources to improve clinic operations.

This may include but is not limited to BOTOX BV/ PA processes, Specialty Pharmacy considerations, patient scheduling procedures, patient tracking, in addition to considerations related to injector capacity and office personnel in the BOTOX treatment continuum
Offers expertise on the BOTOX Savings Program for appropriate patients
Develops ongoing interaction with customers in a manner that anticipates and adapts to their reimbursement information needs as well as market changes / challenges
When appropriate, provide strategic coverage / reimbursement support to Field Sales Leadership to which their geographies align

Reimbursement Counsel:

Responds, as requested, to coding, policy, approved coverage, payment and billing questions from external customers
Support questions about the appeals process as well as denied and partially paid claims
Provides training on how to complete benefit verifications, prior authorizations and research proper policy and forms needed to allow for access to care for all patients
Based on request, completes Reimbursement Analysis and claims reviews for practices
Provides education on Specialty Pharmacy and Buy and Bill acquisition options
Maintains expertise in regional and national payer landscapes, specifically, proper clinical requirements, reimbursement policy, utilization management criteria, prior authorization processes and appeal requirements
Monitor commercial, Medicare and Medicaid communications on coverage, coding and payment, including CMS guidelines and protocols for site of service 19, 22 and 24 patient encounters

Managed Markets and Policy Integration
Monitors Policy Reporter for changes in payer criterion and treatment protocols, analyzes ThoughtSpot data to identify payer trends
Updates customers on policy changes through approved templates and plan approval
Communicates regularly with local and regional managed market personnel on policy changes (Includes regional and national payer plans, PBMs, Medicare and State Medicaid)
Provides feedback from patient navigators on implementation on new payer policies or approval procedures for all payer types
Identifies coverage gaps and computer errors on policy requirements or portal entry challenges that inhibit patient access to care
Provides fact-based policy information to update BOTOX ONE database and inform managed markets

Administrative
Provides approved resources to practices improving the patient's access to care.

Items include, not limited to, approved Coding and Diagnosis, PA Checklists, Charge Sheets, and patient education
Conducts monthly quality audits on work completed by BOTOX ONE for each territory
Properly uses ThoughtSpot, Policy Reporter, Veeva and other analytical tools
Completes an expense report each month
Schedules meetings and educational programs to support the educational needs of the customer
Exhibits ability to conduct virtual and in-person meetings successfully

Communication and Leadership:

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
Builds excellent internal (sales, marketing, training, managed markets, legal, regulatory, and compliance) and external (healthcare providers and staff, billing and financial staff and executive level business personnel) cross-functional relationships with a broad base of groups and individuals
Exhibits high level of aptitude and competency in core RBA skills and the Ways We Work attributes
Demonstrates positive leadership, without authority, to peers, upper management and the various business units by leveraging skills and expertise in account management

Training and Professional Development

:

Actively participates in training and development programs including classroom sessions and field training
Pursues professional education related to healthcare, Urology and Neurosciences
Establishes and executes an Individual Developmental Plan (IDP) to ensure ongoing growth and contribution to business / Abbvie
Completes and maintains Individual Development Plan
Successfully completes assigned training

.

Qualifications

MINIMUM REQUIREMENTS
Education and Experience
Education:

Bachelors' degree, MBA desirable
Experience:

A minimum of

5–7 years of proven success in a health care related field
Previous Sales, District Management, hospital or practice experience- a plus
Experience with Lean Six Sigma principles
Reimbursement-related experience:

Physician-administered injectables
CPT III and/or Miscellaneous J-code reimbursement
Specialty Pharmacy and Buy & Bill acquisition
Benefit Verifications, Prior Authorizations, Claim Assistance, and Appeals

Strong medical and pharmacy reimbursement experience with HUB services
Payer/insurance coverage experience with Medicare, Medicare Advantage, Commercial and Medicaid plans
A Valid Driver's License
Ability to travel adequately to cover territory, as well as overnight travel and attendance at scheduled training and meetings

Skills and Abilities
Proven record of accomplishment in achieving objectives and corporate goals with minimal direct supervision
Excellent time management and prioritization skills
Demonstrated creativity, situation analysis/problem solving skills and analytical skill ability
Excellent communication skills, including written, verbal and listening. Strong presentation and training skills

Outstanding interpersonal skills, including genuine care and concern for others, with a proven ability to establish and maintain strong relationships with key account.

Emotional intelligence and maturity
Good judgment and a positive attitude
Demonstrated leadership and project management skills
Broad business perspective, including a solid working knowledge of office operations and systems
Subject matter expertise within Neurosciences/Urology, strategic planning, business development, and staff management
Proven experience in consulting to include account management, needs assessment, development of practice training and account plans
Core Competencies Include:

Planning, Business Acumen, Technical and Professional Knowledge, Facilitating Change, Driving Results, High-Impact Communication, and Building Trusting Relationships
Corporate Principles:

Ways We Work

This is a remote, field-based opportunity that will cover the following geography:

(Oklahoma and Arkansas The headquarters city for this role is negotiable, as a home base within the territory other than (Oklahoma City) can be considered.

Significant Work Activities
Continuous sitting for prolonged periods (more than 2 consecutive hours in an 8 hour day)
Travel
Yes, 50 % of the Time
Job Type
Experienced
Schedule
Full-time
Job Level Code
M
Equal Employment Opportunity
At AbbVie, we value bringing together individuals from diverse backgrounds to develop new and innovative solutions for patients.

As an equal opportunity employer we do not discriminate on the basis of race, color, religion, national origin, age, sex (including pregnancy), physical or mental disability, medical condition, genetic information gender identity or expression, sexual orientation, marital status, protected veteran status, or any other legally protected characteristic.

Contact Information

Company Name:

Abbvie
Website:

#J-18808-Ljbffr