Glaukos is Growing! Join Our New GPS - Glaukos Patient Services Team

Founded in 1998, Glaukos is publicly traded ophthalmic medical technology and pharmaceutical company focused on developing and commercializing novel therapies for the treatment of glaucoma, corneal disorders and retinal diseases. Our global headquarters is in Aliso Viejo, California, and we have additional locations in the United States, Canada, United Kingdom, Germany, Japan, Australia and Brazil.

Reimbursement Liaison

How will you make an impact?

The Patient Reimbursement Liaison team is part of Glaukos Patient Services (GPS), and will serve as experts in payer policies, patient, and provider support to facilitate appropriate patient access services to ensure patients have access to Glaukos' sight saving technologies.

The Patient Reimbursement Liaison works with physician practices (both private and hospital affiliated institutions). They interact directly with key management personnel, providers and staff members to assure patient access to care. The Patient Reimbursement Liaison appropriately educates HCPs and their office staff on clinical documentation, securing treatment approvals, patient tracking, claim submission, reconciliation management, patient education, drug inventory, patient copay assistance and drug acquisition channels. The Patient Reimbursement Liaison helps HCPs understand barriers that may impede or delay appropriate patient access to treatment and/or prevent optimal patient outcomes. Additionally, the Patient Reimbursement Liaison provides education on appropriate and accurate billing and coding practices for Glaukos' products in line with payer requirements and to the highest levels of specificity.

What will you do?

• Provides HCPs and their office staff education on how to interpret benefit verifications including PA requirements, calculation of patient cost share and drug acquisition options for specific patients enrolled in GPS.
• Collaborates with Patient Support Specialist (PSS) to identify and eliminate barriers to access for patients enrolled in GPS.
• Responds to HCP questions related to coding, payer policy, and approval protocols.
• Offers expertise on navigating copay assistance for appropriate patients enrolled in GPS.
• Provides education on navigating the appeals process as well as denied and partially paid claims, including specialty pharmacy and buy & bill acquisition options.
• Takes lead in completing Business Reviews and Claims Reviews for practices.
• Monitors reimbursement trends (e.g., HCPs receiving notification of policy changes, claim denials, underpayments, etc.) and engages payer team appropriately when patient access may be jeopardized.
• Maintains expertise in regional and national payer landscapes, specifically, proper clinical requirements, reimbursement policy, utilization management criteria, prior authorization processes and appeal requirements.
• Updates customers on policy changes through approved templates and plan approval.
• Identifies coverage gaps and computer errors on policy requirements or portal entry challenges that inhibit patient access to care.
• Ability to travel adequately to cover territory, as well as overnight travel (~50%) and attendance at scheduled training and meetings.

The Patient Reimbursement Liaison consistently demonstrates uncompromised ethics and integrity while helping others understand legal and regulatory parameters related to anti-kickback statutes, fraud and abuse, off-label promotion, and OIG guidance related to patient assistance programs.

This posting is for pipelining efforts due to the growth of our Patient Services Roles.

How will you get here?

• Bachelor's Degree in related field.
• 7+ years of experience working with specialty pharmaceuticals or devices and a minimum of 1 year in a patient access-related position.
• Reimbursement experience with physician-administered injectables and/or medical devices, Category III CPT codes and/or miscellaneous J-codes, specialty pharmacy and buy & bill acquisition, and benefit verifications, prior authorizations, claims assistance, and appeals.
• Payer/insurance coverage experience with Medicare, Medicare Advantage, VA/Tri-Care, Commercial and Medicaid plans.
• Proven record of accomplishment in achieving objectives and corporate goals with minimal direct supervision and demonstrated creativity, situation analysis/problem solving skills and analytical skill ability.
• Significant experience working with a Patient Service Center/Hub.
• Successful navigation of complex authorization processes for specialty medications, Orphan, or Rare disease.
• Educate Healthcare Professionals on the availability of patient support programs such as Co-Pay Assistance and Patient Assistance Programs.

Preferred:

• MBA or MPH preferred.
• Previous sales, district management, field reimbursement, hospital or practice experience preferred.
• Eyecare experience preferred.