Director, Reimbursement Services

US-MD-Columbia
Job ID
2017-1215
# Openings
1
Category
Reimbursement

Primary Purpose of Position

The Director, Reimbursement Services is the primary leader of reimbursement efforts for patients referred into the reimbursement support process and is responsible for monitoring and reporting on key performance metrics for reimbursement. This position acts as the primary liaison between the sales force, the hotline, and the Regional Account Manager team and works directly with the brand team to support critical success factors, recommending any improvements or changes necessary to react to marketplace dynamics. The Director is also responsible for reporting on key metrics as needed for special initiatives.

Principal Responsibilities

 

Responsibilities and duties include, but are not limited to, the following:

  • Provide day to day oversight and management of the hotline services program.
  • Ensure that medical necessity support, including appeal assistance, is effectively deployed in order to support a positive determination, when possible.
  • Leverage clinical insights to review and provide guidance to providers on Insurance Verification Requests (IVRs) in order to improve positive determinations.
  • Manage new IVRs through the reimbursement evaluation process at the hotline, ensuring optimal speed to coverage determination.
  • Direct field reimbursement consultants, as needed, to train and inform provider offices of insurance authorizations or appeals.
  • Triage any payor obstacles to the Market Access team for further research and/or management.
  • Hire and train internal RLAs as needed to support reimbursement and hotline.
  • Lead monthly conference calls with the commercial leadership team to review performance metrics, new and open reimbursement cases and other critical performance requirements.
  • Recommend improvements and process changes to hotline services as necessary, within the scope of company compliance guidelines, to support patient and provider needs.
  • Report weekly and/or as needed on IVRs, PA, medical necessity and other KPIs.
  • Monitor and assess performance measures including IVR turnaround time (ITT), account documentation and the quality of provider submissions.
  • Lead Quarterly Business Reviews with the Market Access team.
  • Escalate customer service and data delivery with the hotline systems, as needed, and monitor resolution of those issues.
  • Oversee ASP submission process with Finance and ensure updates are properly communicated to service providers.
  • Perform other duties as assigned.

Qualifications

 

 

Required

  • Bachelor’s degree.
  • 5+ years of previous pharmaceutical/biotech company experience.
  • 2+ years of experience working with a reimbursement services hotline.
  • 3+ years of experience leading teams and managing people
  • Experience working with multiple projects and managing multiple external partners
  • Extensive knowledge of reimbursement and managed care landscape, reimbursement processes, and hotline operations.
  • Strong analytical, planning, project management, communication, and organization skills.
  • Superior communication and presentation skills.
  • Flexibility to work in a fluid, fast-paced environment and respond quickly to new deadlines.
  • Strong initiative and independence.
  • Team orientation.
  • Strong Microsoft Excel and PowerPoint skills required
  • Ability to travel up to 15%.

Preferred

  • Medical degree – RN or similar.
  • MBA or advanced degree in a related field.
  • Experience in a biotech tissue environment.

Osiris Therapeutics, Inc. is an Equal Opportunity Employer with a commitment to diversity. Applicants are considered on the basis of individual merit without regard to race, color, national or ethnic origin, gender, gender identity, sexual orientation, marital status, veteran status, pregnancy, age, religion, disability, genetic information, or any other characteristic protected by law.

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