Payer Relations Director - Medicare

By joining us as a Payer Relations Director-Medicare (PRD), you will play a pivotal role in ensuring access to innovative healthcare solutions, driving impactful strategies that benefit both patients and providers, and fostering sustainable growth for cutting-edge technologies. You'll make a meaningful daily difference in this dynamic and influential role.

What Will You Do?

As the PRD, you will be at the forefront of shaping the future of healthcare access and innovation. This fully remote, home-based position manages national Medicare coverage, coding, and reimbursement processes with MAC(s) and CMS. You will interact with various stakeholders, including medical professionals, MAC and CMS staff, state government health staffers, state societies, advocacy groups, KOL physicians, and hospital and ASC staff. As an expert in payer policies, you will facilitate appropriate coverage, payment, and utilization of services to ensure patients have the access they need to the care they deserve.

• Promote Collaboration: Work with Sales, Customer Relations, Reimbursement Liaison, and Medical Affairs teams to achieve strategic payer and provider goals, and lay the foundation for coding, coverage, and payment for future technologies.
• Partner with Key Teams: Collaborate with the Glaucoma Reimbursement Liaison Team and leadership to provide expert consultations to KOL physicians and institutional customers, overcome reimbursement barriers, secure favorable coverage and fair payment, and remove obstacles in the reimbursement process.
• Coordinate Reimbursement Efforts: Lead reimbursement support initiatives for KOL healthcare providers to influence payers and state societies, driving favorable coding, coverage, and access decisions.
• Develop and Implement Strategies: Create and execute strategies for Medicare MACs and CMS to secure and maintain coverage for new and existing products, minimize barriers to access, resolve reimbursement issues, and support sales growth for Glaukos-marketed products.
• Support Sales Efforts: Work closely with Sales Leadership and field representatives to meet the reimbursement needs of KOL healthcare providers, ensuring they are equipped to provide the best care possible.
• Build Sustainable Relationships: Cultivate and maintain strong relationships with healthcare stakeholders to support the continued growth of current and future technologies.
• Engage with Key Stakeholders: Develop relationships with key healthcare stakeholders, including Medicare (Parts A, B, C, D), state government health staff, medical groups, and state advocacy and patient/provider groups.
• Network and Advocate: Conduct outreach and build a network with state/local KOL providers, patient advocacy organizations, and healthcare systems to influence favorable coverage and access.

How will you get here?

• 15+ years of industry experience, including 10+ years in Medicare Payer medical devices and biologics (injectable buy and bill drugs); direct biologic launch and ophthalmology experience preferred.
• Expertise in the buy and bill system, Medicare reimbursement processes, and health care reimbursement (T codes, J codes, billing, coding, appeals), with 10+ years of account management experience preferred.
• Minimum 2 years in practice management, billing, revenue cycle, or pharmaceutical/managed care reimbursement, including provider site reimbursement interactions.
• Knowledge of Medicare structure, reimbursement policies, hotline database systems, and ability to analyze and interpret regulations, legislation, and guidelines (AdvaMed, MDMA, BIO, PHARMA).
• Strong communication skills for effective stakeholder interaction, project management abilities, and capacity to work independently.
• Ability to travel overnight 3-4 nights per week; 50%+ travel required.