Reimbursement Business Advisor, Midwest - Eye Care

AbbVie's mission is to discover and deliver innovative medicines and solutions 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, and eye care – and products and services in our Allergan Aesthetics portfolio. For more information about AbbVie, please visit us at www.abbvie.com. Follow @abbvie on Twitter, Facebook, Instagram, YouTube and LinkedIn. 

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.
• 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.

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

• 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.
• Demonstration of key soft skills: Empathy, Critical Thinking, Curiosity, Persistence, Reliability, and Resourcefulness
• Proven and consistent competence of the following skills: Problem Solving, Gain Access, Resource Mastery, Tangible Results, Overcoming Adversity, Collaboration, and Managing Complexities
• Strong history of leadership within current role
• Basic technology and analytical skills (Salesforce, virtual meetings, excel, report interpretation)
• A Valid Driver’s License
• Ability to travel adequately to cover territory, attend training, and meetings. Overnight travel is required.

Applicable only to applicants applying to a position in any location with pay disclosure requirements under state or local law: ​

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• The compensation range described below is the range of possible base pay compensation that the Company believes in good faith it will pay for this role at the time of this posting based on the job grade for this position. Individual compensation paid within this range will depend on many factors including geographic location, and we may ultimately pay more or less than the posted range. This range may be modified in the future.​

• We offer a comprehensive package of benefits including paid time off (vacation, holidays, sick), medical/dental/vision insurance and 401(k) to eligible employees.​

• This job is eligible to participate in our short-term incentive programs. ​

• This job is eligible to participate in our long-term incentive programs​

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Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, incentive, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole and absolute discretion unless and until paid and may be modified at the Company’s sole and absolute discretion, consistent with applicable law. ​

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AbbVie is committed to operating with integrity, driving innovation, transforming lives, serving our community and embracing diversity and inclusion.  It is AbbVie’s policy to employ qualified persons of the greatest ability without discrimination against any employee or applicant for employment because of race, color, religion, national origin, age, sex (including pregnancy), physical or mental disability, medical condition, genetic information, gender identity or expression, sexual orientation, marital status, status as a protected veteran, or any other legally protected group status.