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