Reimbursement Account Director

About Avedro

Avedro is a privately held pharmaceutical and medical device company advancing the science and technology of corneal cross-linking and refractive correction. Avedros Photrexa Viscous, Photrexa and KXL products are approved for sale in the United States for the treatment of progressive keratoconus and corneal ectasia following refractive surgery.

Avedros products sold outside of the United States include capital equipment such as the UV-X devices, the KXL and Mosaic Systems, and related proprietary pharmaceuticals such as the VibeX® and MedioCROSS® formulations. Avedro distributes its products in countries outside of the United States through a network of ophthalmic medical device distributors.

Position Summary

The Reimbursement Account Director (RAD) is responsible for the successful coverage and reimbursement of PHOTREXA, as well as the overall management of coverage, coding, and reimbursement processes within an assigned region encompassing commercial insurance, MAC(s), Medicaid. Successful performance will include establishing favorable payer coverage, ensuring fair and consistent payment, and removing barriers in the overall reimbursement process. The position is also responsible for the coordination and execution of reimbursement support for healthcare providers in the assigned territory. The RAD delivers consultations with physicians and institutional customers through specialized services to assist with reimbursement barriers. This position interacts with a variety of customers to include; physicians, nurses, billing staff, hospital outpatient departments, and ASCs. They will serve as an expert in payer policies and provide support to facilitate appropriate patient access and utilization of services to ensure their access to care. The RAD will promote collaboration with the Sales, Customer Relations, and Medical Affairs teams to achieve payer and provider strategic business goals. This candidate must be organized and detail-oriented. Demonstrated teamwork abilities with high emotional intelligence in managing multiple business initiatives and cross-functional relationships will be a requirement.

Additional job duties:

* Develop and execute managed care and public-sector payer strategies for targeted national and regional plans, as well as MAC/Medicaid that is designed to secure coverage for newly-marketed products, minimize barriers to access, solve reimbursement issues, and support sales for Avedro marketed products.

* Work closely with the Sales Leadership and field sales representatives to appropriately support health care providers with their reimbursement needs.

* Develop sustainable corporate relationship that will allow for continued growth of current and future products.

* Understand and work within our core classes of trade:

* Commercial Managed Care (Regional Plans)

* Medicare (Part A, B, C, D; Carriers)

* Medicaid (Fee for Service, Managed Care Organizations)

* Veterans Administration (VISNs)

* TRICARE Regional Offices

* Specialty Pharmacy & Pharmacy Benefit Managers

* ACOs and other Integrated Delivery Networks (IDNs)

* Advocacy, consumer, provider and treatment systems groups

* Required outreach and networking with state/local provider, patient and healthcare systems advocacy organizations.

Education and experience requirements:

* Bachelors degree. Advanced degree or specific Practice Management experience preferred.

* At least 5 years of field biologics experience, ideally with injectable drugs. Direct biologic launch experience highly desirable. Ophthalmology experience preferred.

* In depth knowledge of the buy and bill system.

* 3+ years of reimbursement and account management experience preferred.

* Minimum 2 years of experience in: practice management, or practice billing and revenue cycle; experience with public or private third-party reimbursement related to product access impact on providers; or experience in pharmaceutical or managed care industry reimbursement including provider site reimbursement interactions

* Knowledge of private payer, Medicare and Medicaid structure systems and reimbursement process.

* Technical knowledge of health care reimbursement from a patient and provider perspective (miscellaneous J codes, billing coding, appeals process)

* Knowledge of reimbursement policies and hotline database systems.

* Ability to travel overnight for 3-4 nights per week; 50% travel

* Strong communication skills; ability to effectively interact with physicians and their staff.

* Ability to analyze and interpret regulation and legislation.

* In depth knowledge and understanding of PHARMA Guidelines.

* Project management skills and the ability to work independently.

* Live within 45-minute drive of major airport (No relocation assistance is available)

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