Field Reimbursement Manager Eye Care - Chicago IL

Talent will be hired at a level commensurate with experience.

The Field Reimbursement Manager (FRM) 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 FRM 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 FRM offers approved tools and standardization methods to provide reimbursement and technical knowledge to gain patient access while reducing access challenges. The FRM 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 problemsolving 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 needsbased resources such as HUB services patient savings programs and managing payer/coverage pullthrough 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 needbased 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 businessoriented decision makers including CSuite 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 fastpaced changing environment
• The employee conducts all work activities in compliance with all Abbvie internal requirements and with all applicable regulatory requirements.

Driving a personal auto or company car or truck or a powered piece of material handling equipment

Qualifications :

• A minimum of 57 years of proven success in a health care related field including access and reimbursement experience
• Bachelors degree required.
• Preferred experience includes previous sales District Management Hospital Market Access Access and Reimbursement or practice/administrator experience.
• Beneficial exposure to Jcodes and ophthalmology procedures and surgeries medical devices CPT I & III and/or Jcode 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
• Welldeveloped verbal and written communication skills including inperson 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 Drivers License
• Ability to travel adequately to cover territory attend training and meetings. Overnight travel is required.

Additional Information :

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

• 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 shortterm incentive programs. 

• This job is eligible to participate in our longterm incentive programs

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 Companys sole and absolute discretion unless and until paid and may be modified at the Companys sole and absolute discretion consistent with applicable law. 

AbbVie is an equal opportunity employer and is committed to operating with integrity driving innovation transforming lives serving our community and embracing diversity and inclusion.  It is AbbVies 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.

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