In this field-based position, the Reimbursement Account Specialist (RAS) will report to the National Director, Managed Markets. The RAS will be the field subject matter expert related to billing and coding education and will be responsible for the management of practice level reimbursement and access for ILUVIEN. The RAS will help support ILUVIEN reimbursement through the development of relationships with Practice Administrators/Managers and Billing Managers/staff.
In addition, the RAS will work closely with the ILUVIEN Reimbursement Hub, AccessPlus, to provide comprehensive support and assistance to physician practices and institutional accounts for coverage, reimbursement and access guidance for ILUVIEN. The RAS will work directly with sales team members to optimize access for Iluvien across sales regions and capture ILUVIEN treatment information.
The RAS will also collaborate closely with the Payer Relations Director regarding local and regional coverage and policy decisions, resolution of payer related issues, and specialty pharmacy access within the assigned geography. In addition, the RAS will provide critical competitive intelligence on business trends within key accounts and coverage trends with local, regional and national payers. An important RAS goal is to maximize reimbursement confidence for ILUVIEN, minimize ILUVIEN access barriers and promote/implement various programs and services to supplement the field sales force and management efforts.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
The Reimbursement Account Specialist (RAS) will be the subject matter expert on product procurement as it relates to the buy & bill process, specialty pharmacy process, reimbursement (billing and coding) education, financial assistance options for ILUVIEN, and issue resolution pertaining to the purchase, billing and reimbursement of ILUVIEN.
The RAS will work closely with the ILUVIEN Reimbursement Hub team (AccessPlus) to provide guidance, expertise and pull-through/follow up for individual case management.
The RAS provides office level and institution-based reimbursement support in order to instill critical reimbursement confidence within the retina community to support ILUVIEN.
The RAS team, in conjunction with the Payer Relations Director team, will be responsible for optimizing pull-through of the managed markets strategy at the local and regional level, monitoring managed care, reimbursement and policy activities, as well as business trends relevant to Alimera Sciences and ILUVIEN.
The RAS will establish relationships with a variety of stakeholders within their geography: Practice Administrators, Practice Managers, Billing Managers, Billing Staff and Retina Specialists.
The RAS will work closely with sales team to prioritize business and reimbursement needs and to communicate any payer issues or payer-specific strategies.
RAS members also educate, train and support the regional sales team on all reimbursement items as needed for cross-functional support.
Proactively identify potential marketplace trends/barriers within respective geographies regarding ILUVIEN.
Reactively respond to any reimbursement or coverage issues and market access challenges for ILUVIEN within their geographies.
Provide marketplace surveillance and analysis on ILUVIEN access issues and competitive landscape.
Knowledge regarding various market segments including reimbursement and coverage, patient access and financial assistance, health plans/federal marketplace, and physician networks.
Strong knowledge and understanding of the commercial payer landscape and policy activity, Medicare Part B, Medicare Advantage plans, Medicare Supplemental plans and Medicaid (fee for service and managed plans).
Proficient in all aspects of reimbursement (i.e. Benefits investigations, payer reimbursement policies, regulatory and administrative rules)
Understands reimbursement/funding resources and how to access those resources
Knowledge of managed care industry including government payers
Strong understanding and experience supporting physician-administered products, especially in the provider office setting.
Expert problem-solving skills with a demonstrated team orientation.
Excellent investigational and analytical skills.
Demonstrated ability to manage multiple situations with the ability to prioritize work with a sense of urgency.
Demonstrated leadership skills and ability to lead without authority with internal and external stakeholders.
Ability to work cross-functionally within various departments, with an emphasis on the sales department.
Demonstrated ability to work in a fast paced, entrepreneurial environment.
Excellent verbal and written communication skills.
Ability to function as a self-starter with a high level of energy and drive for success.
Ability to rapidly assimilate information and then prioritize and manage to timelines.
Ability to cultivate spheres of influence.
Strong interpersonal skills.
Ability to multi-task.
EDUCATION & EXPERIENCE:
Significant experience in the pharmaceutical/biotech industry in a sales or market access role.
Minimum 2 years' experience in a practice facing, field-based reimbursement role providing billing and coding education, coverage and policy guidance, follow up and issue resolution pertaining to the purchase, billing and reimbursement of a physician-administered biologic.
Experience calling payers regarding benefit coverage or claim related issues.
Billing and Coding training or certification preferred.
Experience in the retina specialty a plus.
Ability to travel up to 30% in assigned region including overnights and as business dictates.
BA degree required.
Alimera Sciences, Inc. is an equal opportunity employer EEO/AA and strongly supports diversity in the workplace. All qualified applicants will receive consideration without regard to race, color, religion, gender, sexual orientation, national origin, age, gender identity, genetic information, status as a qualified individual with a disability or Vietnam era or other protected veteran. M/F/V/D