Reimbursement Business Advisor, Eye Care

4 weeks ago

Baltimore Maryland, United States AbbVie Full time
Job Description

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.

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.

Monitor and provide updates on Local, Regional and National Payers. Examples include criteria changes or barriers in medical policy, Prior Authorization requirements, coding changes, claim submission 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.

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.

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