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Reimbursement Business Advisor, Botox

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Troy, United States AbbVie Full time
Job DescriptionJob DescriptionCompany Description

AbbVie's mission is to discover and deliver innovative medicines and solutions 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, and eye care – and products and services in our Allergan Aesthetics portfolio. For more information about AbbVie, please visit us at www.abbvie.com. Follow @abbvie on Twitter, Facebook, Instagram, YouTube and LinkedIn. 

Job Description

The Reimbursement Business Advisor (RBA) shares expertise and educates on Medical and Pharmacy benefits, Buy & Bill and Specialty Pharmacy acquisition, payor policy, appropriate patient identification, clinical documentation, benefit investigation results, prior authorizations, billing, coding, patient tracking, claim submission, reconciliation management, patient financial savings programs, patient tracking/retreatment, and the denial/appeal process for the approved indications for BOTOX® Therapeutics. The RBA clarifies barriers that may impede or delay appropriate patient access to treatment and/or prevent optimal patient outcomes. The RBA may interact with healthcare providers, administrative staff, revenue cycle management, and institutional leadership.

After the patient has been identified by an ABS provider, the RBA offers approved tools and standardization methods to provide reimbursement and technical knowledge to gain patient access while reducing access challenges.

Responsibilities

  • Educate on the fundamentals of the BOTOX treatment process, appropriate  reimbursement, and understanding the payer landscape
  • Leverages advance problem-solving and analytical skills to identify access and reimbursement barriers while offering actionable insights to desired and approved care
  • Uncover the root cause to access issues impeding or delaying proper treatment
  • Monitor and provide updates on both Region and National Payers. Examples include changes or barriers in medical policy, Prior Authorization requirements, or product acquisition. Apply compliant methods to exchange critical information
  • Work collaboratively and function as a liaison for information between various internal stakeholders such as: Market Access, Center of Excellence, Sales, Marketing, Training, Compliance, Trade, and Specialty Pharmacy groups.
  • Provide customer feedback relating to approval requirements and access to care barriers with AbbVie stakeholders (Market Access, Center of Excellence, Sales, Marketing, Trade, Specialty Pharmacy, Senior Leadership) 
  • Educate accounts on need-based tools to support patient access.  Examples include HUB services, patient savings programs, payer coverage details, and acquisition pull-through initiatives
  • Proficient in providing analytical and customized need-based solutions to problems in complex environments and matrix influenced health systems and practices
  • Establish and maintain respectful working relationships with healthcare professionals and staff as well as business-oriented decision makers including C-Suite level executives within territory
  • Demonstrates the ability to lead without authority and effectively communicate with diverse groups with sometimes different priorities
  • Capable of influencing across functions to gain consensus on agreed upon patient solutions
  • Ability to professionally deliver crucial conversations that may contain less than desirable information or facts
  • Proactively engage in Field Input Teams offering innovative solutions to problems in a fast-paced changing environment
  • Share customer challenges and suggest potential solutions to address obstacles
  • Demonstrate effective planning, prioritization, follow up, and anticipates problems
  • The employee conducts all work activities in compliance with all Abbvie internal requirements and with all applicable regulatory requirements

Continuous sitting for prolonged periods (more than 2 consecutive hours in an 8 hr day) is required

Driving a personal auto or company car or truck, or a powered piece of material handling equipment

Qualifications

  • A minimum of 5–7 years of proven success in a health care related field
  • Bachelor’s degree required
  • Preferred experience includes Previous Sales, District Management, Hospital, Managed Markets, Access and Reimbursement, or practice experience
  • Knowledge of Lean Six Sigma principles is favorable
  • Exposure to physician-administered injectables, CPT and/or J-code reimbursement, Specialty Pharmacy and Buy & Bill acquisition, Benefit Verifications, Prior Authorizations, Claim Assistance, Appeals and payor policies, and HUB services
  • Proven record of comprehensive work with accounts at all levels
  • Payer/insurance coverage experience with Medicare, Medicare Advantage, Commercial and Medicaid plans
  • Well-developed verbal and written communication skills, including in-person and virtual  presentation skills of complex information and processes
  • Proven and consistent competence of the following skills:  Problem Solving, Gain Access, Resource Mastery, Tangible Results, Overcoming Adversity, Collaboration, and Managing Complexities
  • Demonstration of key soft skills:  Empathy, Critical Thinking, Curiosity, Persistence, Reliability, and Resourcefulness
  • Strong history of leadership within current role
  • Technology and analytical skills (Salesforce, virtual meetings, excel, report interpretation)
  • A Valid Driver’s License
  • Ability to travel adequately to cover territory, attend training, and meetings. Some overnight travel may be required


Additional Information

Applicable only to applicants applying to a position in any location with pay disclosure requirements under state or local law: ​

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  • The compensation range described below is the range of possible base pay compensation that the Company believes in good faith it will pay for this role at the time of this posting based on the job grade for this position. Individual compensation paid within this range will depend on many factors including geographic location, and we may ultimately pay more or less than the posted range. This range may be modified in the future.​

  • We offer a comprehensive package of benefits including paid time off (vacation, holidays, sick), medical/dental/vision insurance and 401(k) to eligible employees.​

  • This job is eligible to participate in our short-term incentive programs. ​

  • This job is eligible to participate in our long-term incentive programs​

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Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, incentive, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole and absolute discretion unless and until paid and may be modified at the Company’s sole and absolute discretion, consistent with applicable law. ​

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AbbVie is committed to operating with integrity, driving innovation, transforming lives, serving our community and embracing diversity and inclusion.  It is AbbVie’s policy to employ qualified persons of the greatest ability without discrimination against any employee or applicant for employment because 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, status as a protected veteran, or any other legally protected group status.