Job Description Summary
Implements and maintains a variety of operational functions in support of the sales force, such as territory alignment, monitoring the sales effort within territories; periodically publishing sales activity reports of various territories, districts, or regions. Participates in the organization of sales meetings at the district, regional, and national levels. Develops analyses to measure the trends, efficiencies, and effectiveness of account representatives' marketing and sales resource allocation and utilization. Coordinates the implementation of approved sales incentive programs. May be responsible for sample accountability.
Job Description
• Work with payers, specialty pharmacies, physician champions, and professional societies to secure adequate reimbursement of CSL Behring Therapies
• Aid physicians, sites of service and their support staff in the reimbursement process
• Provide in-service training to sales and marketing on the fundamentals of healthcare economics
• Execute reimbursement strategies that proactively integrate and align with marketing and sales strategies
• Execute strategies with third party payers to insure adequate reimbursement (hospitals, home health providers, ambulatory care centers and physicians)
• Work directly with third party payers and Medicare offices to insure adequate reimbursement for our products
• Provide monthly report recounting significant activities, progress and follow-up needed
• Assess reimbursement environment (coverage, coding and payment) for any new products and procedures
Assists director with the relationship and application processes with key federal and state agencies. This would include but not be limited to: influencing public and private insurance coverage decisions and outcomes and assuring appropriate coding for reimbursement of all components of care. Drives the reimbursement for federal payer programs under Health & Human Services and Medicare (CMS) including 340b, Medicare/MAC, and Durable Medical Equipment Carriers (DMERC/DME MAC). Develops and maintains key relationships and communicates with Medicare decision makers (i.e. Dir. of Ambulatory Services, Medicare Ombudsmen, Product Safeguard Contractors, and DME MAC to drive appropriate coverage decisions impacting CSL therapies.
Serving as a member of all new product launch teams, including supporting all components of reimbursement coding for new products and future modifications. Will support Director with all necessary applications to Federal and State payer programs including Medicare and Medicaid for all new product launches.
In conjunction with the training department develop and conduct reimbursement training and educational materials for CSL field based and as appropriate home office personnel. Works in conjunction with the filed based reimbursement specialist to develop and present reimbursement training materials for healthcare providers (Specialty Pharmacies, distributors, hospitals, physicians, etc.).
Monitor and oversee the updating of all product reimbursement guidelines (print and reimbursement web site).
Maintain CSL Reimbursement web site to include: reimbursement-news alerts, Medical Coding updates (HCPCS, CPT, ICD9, ICD10), and news releases from Medicare (CMS).
Requires 50-60% domestic travel.
Position Qualifications and Experience Requirements
Provide hiring requirements for the specified position, including educational, experiential, and competency requirements necessary for the position.
Education
• Bachelor's degree required
Experience
• 5-8 years' experience in a field reimbursement capacity.
• Excellent understanding of private and public insurance policies. Prior reimbursement and or case management experience required.
• Strong understanding of Medicare Polices. Work experience with patient advocacy groups regarding coverage policies preferred.
Competencies
• Dealing with ambiguity
• Healthcare Policy and Reimbursement technical knowledge
• Command skills
• Customer Focused
• Ethics and values
• Written communications
• Interpersonal savvy
Requires 50-60% domestic travel.
