Reimbursement Business Advisor
AbbVie's mission is to discover and deliver innovative medicines and solutions that solve serious health issues today and address the medical challenges of tomorrow. We strive to have a remarkable impact on people's lives across several key therapeutic areas immunology, oncology, neuroscience, and eye care and products and services in our Allergan Aesthetics portfolio.
The Reimbursement Business Advisor (RBA) shares expertise and educates on medical and pharmacy benefits, buy & bill and specialty pharmacy acquisition, payor policy, appropriate patient identification, clinical documentation, benefit investigation results, prior authorizations, billing, coding, patient tracking, claim submission, reconciliation management, patient financial savings programs, patient tracking / retreatment, and the denial / appeal process for the approved indications for BOTOX Therapeutics. The RBA clarifies barriers that may impede or delay appropriate patient access to treatment and / or prevent optimal patient outcomes. The RBA may interact with healthcare providers, administrative staff, revenue cycle management, and institutional leadership. After the patient has been identified by an ABS provider, the RBA offers approved tools and standardization methods to provide reimbursement and technical knowledge to gain patient access while reducing access challenges.
The RBA :
- Educates on the fundamentals of the BOTOX treatment process, appropriate reimbursement, and understanding the payer landscape.
- Leverages advanced problem-solving and analytical skills to identify access and reimbursement barriers while offering actionable insights to desired and approved care.
- Uncovers the root cause to access issues impeding or delaying proper treatment.
- Monitors and provides updates on both region and national payers. Examples include changes or barriers in medical policy, prior authorization requirements, or product acquisition.
- Works collaboratively and functions as a liaison for information between various internal stakeholders such as : Market Access, Center of Excellence, Sales, Marketing, Training, Compliance, Trade, and Specialty Pharmacy groups.
- Provides customer feedback relating to approval requirements and access to care barriers with AbbVie stakeholders (Market Access, Center of Excellence, Sales, Marketing, Trade, Specialty Pharmacy, Senior Leadership).
- Educates accounts on need-based tools to support patient access. Examples include HUB services, patient savings programs, payer coverage details, and acquisition pull-through initiatives.
- Is proficient in providing analytical and customized need-based solutions to problems in complex environments and matrix influenced health systems and practices.
- Establishes and maintains respectful working relationships with healthcare professionals and staff as well as business-oriented decision makers including C-Suite level executives within territory.
- Demonstrates the ability to lead without authority and effectively communicate with diverse groups with sometimes different priorities.
- Is capable of influencing across functions to gain consensus on agreed upon patient solutions.
- Is able to professionally deliver crucial conversations that may contain less than desirable information or facts.
- Proactively engages in Field Input Teams offering innovative solutions to problems in a fast-paced changing environment.
- Shares customer challenges and suggests potential solutions to address obstacles.
- Demonstrates effective planning, prioritization, follow up, and anticipates problems.
- Conducts all work activities in compliance with all AbbVie internal requirements and with all applicable regulatory requirements.
Qualifications :
A minimum of 57 years of proven success in a health care related field.Bachelor's degree required.Preferred experience includes previous sales, district management, hospital, managed markets, access and reimbursement, or practice experience.Knowledge of Lean Six Sigma principles is favorable.Exposure to physician-administered injectables, CPT and / or J-code reimbursement, specialty pharmacy and buy & bill acquisition, benefit verifications, prior authorizations, claim assistance, appeals, and payor policies, and HUB services.Proven record of comprehensive work with accounts at all levels.Payer / insurance coverage experience with Medicare, Medicare Advantage, commercial, and Medicaid plans.Well-developed verbal and written communication skills, including in-person and virtual presentation skills of complex information and processes.Proven and consistent competence of the following skills : problem solving, gain access, resource mastery, tangible results, overcoming adversity, collaboration, and managing complexities.Demonstration of key soft skills : empathy, critical thinking, curiosity, persistence, reliability, and resourcefulness.Strong history of leadership within current role.Technology and analytical skills (Salesforce, virtual meetings, excel, report interpretation).A valid driver's license.Ability to travel adequately to cover territory, attend training, and meetings. Some overnight travel may be required.Additional Information :
The compensation range described below is the range of possible base pay compensation that the Company believes in good faith it will pay for this role at the time of this posting based on the job grade for this position. Individual compensation paid within this range will depend on many factors including geographic location, and we may ultimately pay more or less than the posted range. This range may be modified in the future.
We offer a comprehensive package of benefits including paid time off (vacation, holidays, sick), medical / dental / vision insurance and 401(k) to eligible employees.
This job is eligible to participate in our short-term incentive programs.
This job is eligible to participate in our long-term incentive programs.
Note : No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, incentive, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole and absolute discretion unless and until paid and may be modified at the Company's sole and absolute discretion, consistent with applicable law. AbbVie is an equal opportunity employer and is committed to operating with integrity, driving innovation, transforming lives and serving our community. Equal Opportunity Employer / Veterans / Disabled. US & Puerto Rico only.