Field Reimbursement Director
Glaukos Corporation is an ophthalmic medical technology and pharmaceuticalcompany focused on the development and commercialization of novel surgicaldevices and sustained pharmaceutical therapies designed to transform thetreatment of glaucoma, one of the world’s leading causes of blindness.
The company pioneered Micro-Invasive Glaucoma Surgery, or MIGS,in order to revolutionize the traditional glaucoma treatment and managementparadigm. Glaukos launched the iStent®, its first MIGS device, in the UnitedStates in 2012 and is leveraging its platform technology to build acomprehensive and proprietary portfolio of micro-scale injectable therapiesdesigned to address the complete range of glaucoma disease states andprogression.
The company’s second-generation MIGS device, the iStent inject®Trabecular Micro-Bypass System, was approved by the Food and DrugAdministration, or FDA in June 2018. The company believes the iStent inject,®measuring 0.23 mm wide and 0.36 mm long, is the smallest medical device everapproved by the FDA.
In June 2015, Glaukos completed an initial public offeringand our shares are now traded on the New York Stock Exchange under theticker symbol “GKOS”. The company was founded in 1998 and is based in SanClemente, California.
The Field Reimbursement Director - Midwest position is focused on providing internal and external customers with complete and accurate information on coding, coverage and payment, as well as obtaining coverage and adequate payment from regional payers/economic buyers for Glaukos devices. Additionally, this position is to assist the US sales force in discussing practice economics, hospital economics, and provider reimbursement with key targeted customers. Duties include tactical activities in support of customers and field based sales personnel to support the adoption of Glaukos devices. Key functions to include coding and payment analysis, health technology assessment preparation, insurance authorization analysis, coverage analysis, cost effectiveness analysis, and building relationships with regional payers and targeted providers Creates awareness among key healthcare decision makers and payers to ensure a favorable government and private reimbursement environment, improving acceptance and increasing adoption of Glaukos devices and the procedures in which they are utilized. Works with key targeted providers to assist
Develop and implement a focused payer and managed care plan based on key local and regional government and commercial payers:
Identifies the managed health care opportunities and barriers to entry. Works with assigned payers and providers to establish or change coverage and payment policies.
Develops and manages a network of payer reimbursement contacts and data to assist in the research and tactical implementation of the payer plan.
Establishes strong relationships as the key contact with payers by fostering mutually beneficial long term benefits.
Works with medical societies representing physician customers to achieve appropriate coding and payment.
Provide informational programs and collateral support materials to Glaukos customers to optimize product reimbursement:
Delivers presentations to payers to establish and/or improve reimbursement coverage policies, coding and payment assignments utilizing available resources:
- Health Economics
- Comparative Effectiveness Data
- Key Opinion Leader Physicians
Works with state and local professional societies as well as federal agencies to ensure patient access.
Works with internal reimbursement team, and external reimbursement consultants as appropriate, to develop tools for customers focused on creating access for patients, through accurate and current coding information.
Works with new and existing accounts to identify and coordinate education needs.
Evaluates incoming requests from the field and ensures each request is properly evaluated for feasibility, technical risk, cost and time constraints, compliance and other relevant considerations.
Distributes pre authorization materials, accurate information to customers; tracks and reports on trends.
Assists in addressing appeals for authorization and payment.
Manages hotline, email and web inquiries on a timely basis.
Promotes reimbursement support and represents the company to external customers by writing, phoning, visiting, hosting and participating in events.
Remains aware of changing reimbursement environment by interacting with field contacts, attending professional seminars/conferences and reading industry journals and web news.
Evaluates levels of customer support and improves them.
Provide informational programs and collateral support to Glaukos customers to support practice economics around Glaukos portfolio products:
Working with the regional business managers, provide customers with latest provider reimbursement and facility reimbursement education
Works to educate targeted customers on practice economics when using Glaukos portfolio products
Leads discussions with financial decision makers in hospitals, ASC, and physician groups on the economics of Glaukos portfolio products
Develops materials to effectively communicate the economics of Glaukos portfolio products.
Daily activities include:
Works to solve situational reimbursement/coverage related issues as they arise.
Provide accurate and current information to Glaukos customers to support field sales through management of reimbursement issues and programs, interpretation of policy and training of physicians, facilities and staff members in reimbursement and coding.
Assist customers with achieving appropriate reimbursement and understanding reimbursement tactics for meeting payer requirements for documentation of medical necessity.
Respond to coverage, coding, and payment inquiries from providers by offering objective information based upon qualified and recognized reimbursement sources that may assist the physician in making an informed coding determination based on the procedure to be performed with a Glaukos device.
Track payer/provider trends by geography.
Other duties as assigned.
8+ years of experience in reimbursement / healthcare policy development
• Knowledge of managed care and health insurance industry
• Demonstrated knowledge and experience in payer (Medicare, Medicaid, and Private) policies, reimbursement process and the health care legislative environment
• Experience in interacting effectively with payer decision-makers, health care reimbursement professionals and local carrier medical directors
• Experience in using clinical data to support reimbursement position in presentations
• Knowledge of health care provider issues related to reimbursement and practice economics
• Experience working with organizational decision makers – marketing, regulatory and sales managers
• Experience working directly with sales representatives
• Experience working with reimbursement strategies and tactics
• Working knowledge of computer software including Word, Excel, PowerPoint and MS Project
• Project management skills
• Ability to travel to payer and prospective customer/customer sites
• Ability to follow and implement policies and procedures required of this position
• Detailed knowledge of insurance companies including government payers (Medicare, Medicaid, Tricare) and private payers (PPOs and HMOs) with regard to professional and facility payment systems
• Effective communication and presentation skills, strong telephone skills
• Attention to detail
• Well-organized, self-motivated
• Occasional weekend work commitment
Bachelor (BA/BS) degree and 5+ years of experience in reimbursement and healthcare policy development.
We offer competitive salary (based on experience),bonus eligibility, medical/dental/vision, life insurance, stockoptions, 401(k) Employer Match, 3 weeks paid time off, 13 company paidholidays, Employee Stock Purchase Program and 2 additional paid days off tovolunteer in our community, plus the opportunity to work for a companythat is pioneering a new glaucoma treatment class. Check out our profileon The Muse toget an inside look at our company culture.
Glaukos Corporation is an Equal Opportunity/AffirmativeAction Employer. All qualified applicantswill receive consideration for employment without regard to race, color,religion, sex including sexual orientation and gender identity, nationalorigin, disability, protected Veteran Status, or any other characteristicprotected by applicable federal, state, or local law.