Director, Payor Account Management reports to the Head, Global Market Access, Surgical Glaucoma and is responsible for developing and managing strategic relationships with national and regional health plans and other third-party payors. This role will lead a team of Regional Account Managers (RAMs) to ensure that the Elios System will be positioned favorably with payors, integrated delivery networks, and key hospitals to maximize patient access and organizational revenue. The Director will also partner cross-functionally with members of the sales, marketing, and medical / clinical affairs teams to inform the health economic outcomes research (HEOR) strategy required to obtain and maintain optimal coverage and reimbursement in the U.S.
Responsibilities:- Lead the development and execution of National and Regional payor coverage and reimbursement strategies to ensure key clinical, HEOR data and overall value propositions result in payor coverage and appropriate reimbursement, commercial viability, and unfettered patient access to the Elios System.
- Engage with health technology assessment firms (HTAs) to provide up-to-date reviews of excimer laser trabeculotomy (ELT) and Elios System clinical data and provide education and materials in support of positive conclusions from peer reviewed clinical literature.
- Develop and maintain strong relationships with target payors and build a working knowledge of their key processes including medical policy, utilization review, PMPM thresholds, health outcomes, risk management, provider contracting, and claims processing.
- Develop relationships with State level Ophthalmology Advisory Committee members and payor Medical Directors (key influencers for our indications) for public and private payors to support changes that reflect local medical practices.
- Effectively leverage and communicate PRC approved payor presentation inclusive of published literature to payors, demonstrating Elios System's value that positively influences coverage policy development.
- Monitor Medicare FFS, Medicare Advantage, Commercial payor coverage policies, track review periods, and analyze data on medical review, prior authorization, and claims payment trends to inform payor strategy, tactics, and team priorities.
- Collaborate with Field Sales Managers as needed with key accounts to ensure coverage, coding and payment requirements are understood and met.
- Work with Medical Affairs to support Clinical Education with key local KOLs to influence payor coverage and medical review policies.
- Improve effectiveness and focus of industry alliances, e.g., MDMA, OOSS, as needed to support Medicare and commercial payor policy and patient access.
- Provide internal and external voice-of-customer (VOC) feedback to guide strategy development.
- Assist Head of Market Access with ensuring MACs provide appropriate coverage and payment for ELIOS (MPFS, ASC, HOPD)
- Assist in development of market access programs to train Sales Representatives
Qualifications:- Bachelor's degree in public health, life science, graduate degree, and ophthalmology experience preferred.
- 5-7 years of payor relations experience at Medicare and Private Insurance, e.g., National, and/or regional level, strong knowledge of medical device reimbursement, CPT coding. Proven track record in securing positive payor coverage and reimbursement with medical devices.
- Demonstrated success in securing coverage for new and emerging technologies and influencing payor coverage policies.
- Strong understanding and ability to communicate clinical and economic data, coding, coverage, and payment issues.
- Comprehensive understanding of the current and evolving payor ophthalmology management landscape, i.e. MIGS and cataract perspective.
- Exceptional customer business planning, tactical planning, working with ambiguity and successful execution skills.
- Strong leadership, communication, and collaboration skills and the ability to drive consensus.
- Strong understanding and acumen in reimbursement principles across multiple sites of care, i.e., physician offices, ambulatory surgery centers, hospital outpatient department.
- Strong written and presentation skills to executive management (internal and external).
- Proficient in Microsoft PowerPoint, Excel, and Word.
- Ability to travel 25 - 50%
For U.S. locations that require disclosure of compensation, the starting pay for this role is between $140,000.00 and $185,000.00. The estimated salary range reflects an anticipated range for this position. The actual base salary offered may depend on a variety of factors.
U.S. based employees may be eligible for short-term and/or long-term incentives. They may also be eligible to participate in medical, dental, vision insurance, disability and life insurance, a 401(k) plan and company match, a tuition reimbursement program (select degrees), company holidays, and well-being benefits, among others. U.S. based employees are also eligible to receive sick time, floating holidays and paid vacation.
