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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 www.abbvie.com. Follow @abbvie on Twitter, Facebook, Instagram, YouTube and LinkedIn.

Business Advisor, Reimbursement - BOTOX - OK, AR

Oklahoma City, Oklahoma Req ID 2205939 Category Sales Division AbbVie
  • 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
ABBVIE

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