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Reimbursement Business Advisor, Midwest
3 months ago
**Company Description**
**_
Talent will be hired at a level commensurate with experience._**
The Reimbursement Business Advisor (RBA) educates health care professionals (HCP), administrative staff, and surgical facilities on patient access and reimbursement methods for approved indications for DURYSTA, OZURDEX, and XEN Gel Stent. These elements include appropriate patient identification, clinical documentation, payor policy, benefit investigation results, prior authorizations, billing, coding, patient tracking, claim submission, reconciliation management, patient financial savings programs, drug acquisition channels, and the denial/appeal process. The RBA clarifies barriers that may impede or delay appropriate patient access to treatment and/or prevent optimal patient outcomes. 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. The RBA may interact with healthcare providers, administrative staff, revenue cycle management, and institutional leadership.
**Responsibilities**:
- Educate on the fundamentals of Durysta, Ozurdex and XEN Gel Stent reimbursement process, appropriate reimbursement, and respective payer landscape.
- Demonstrates competence in the following areas: medical and pharmacy benefits, Buy & Bill products, specialty pharmacy, injectables, medical devices, payer policy, and CMS fee schedules for physicians and facilities.
- 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
- Educate health care providers, support staff, and ASCs and HOPDs to alleviate reimbursement barriers and understand the payer landscape and address access issues.
- Provide expertise regarding national/regional/local payer policies to educate on payer policy, coding changes, and appropriate claims submission process.
- Educate health care provider accounts to support patient access for DURYSTA, OZURDEX, and XEN Gel Stent through needs-based resources, such as HUB services, patient savings programs and managing payer/coverage pull-through initiatives.
- Provide in person and virtual meetings to educate HCPs on patient access procedures and uncover barriers access to care.
- Establish and maintain relationships with appropriate healthcare professionals and staff within territory.
- Proficient in providing analytical and customized need-based solutions to problems in complex environments and matrix influenced health systems, Private Equity groups 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.
- 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.
- 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.
- Report back payer trends related for approved products to Patient Services and Market Access teams.
- Proactively engage in Field Input Teams offering innovative solutions to problems in a fast-paced changing environment
- 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 including access and reimbursement experience
- Bachelor’s degree required.
- Preferred experience includes previous sales, District Management, Hospital, Market Access, Access and Reimbursement, or practice/administrator experience.
- Beneficial exposure to J-codes and ophthalmology procedures and surgeries, medical devices, CPT I & III and/or J-code reimbursement, Specialty Pharmacy and Buy & Bill acquisition, Benefit Verifications, Prior Authorizations, Claim Assistance, Appeals and payer policies, and HUB services.
- Extensive experience educating others on payer processes, requirement for coverage, and other access related situations for specialty medicines and/or medical devices.
- Payer 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.
- Demon
