Senior Reimbursement Manager, South West Region

CSL Behring - Hamilton, ON (13 months ago)

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About CSL
With operations in 35+ nations and ~ 22,000 employees worldwide, CSL is driven to develop and deliver a broad range of lifesaving therapies to treat disorders such as hemophilia and primary immune deficiencies, and vaccines to prevent influenza. Our therapies are also used in cardiac surgery, organ transplantation and burn treatment.

CSL is the parent company of CSL Behring and Seqirus. CSL Behring is a global leader in the protein biotherapeutics industry, focused on bringing to market biotherapies used to treat serious and often rare conditions. CSL Behring operates CSL Plasma , one of the world's largest collectors of human plasma, which is used to create CSL's therapies. Seqirus is the second largest influenza vaccine company in the world and is a transcontinental partner in pandemic preparedness and a major contributor to the prevention and control of influenza globally.

We invite you to take a look at the many career possibilities available around the globe and consider building your promising future at CSL by becoming a member of our team!

Job Description
Ideally candidates need to reside in any of the following areas: Houston, Albuquerque, Phoenix, Denver, San Diego. Supports commercial operations core business processes for assigned area Develops strategies and recommendations for improving processes, efficiency and practices. Identifies and prioritizes service improvement opportunities and creates plans for implementation. May focus on data services, patient services, distribution, contracts, corporate donations, reimbursement, forecasting/analytics, or compliance etc. Responsibilities:
  • Work with payers, specialty pharmacies, physician champions, and professional societies to secure adequate reimbursement of CSL Behring Therapies
  • Aid physicians, sites of service and their support staff in the reimbursement process
  • Provide in-service training to sales and marketing on the fundamentals of healthcare economics
  • Execute reimbursement strategies that proactively integrate and align with marketing and sales strategies.
  • Execute strategies with third party payers to insure adequate reimbursement (hospitals, home health providers, ambulatory care centers and physicians)
  • Provide monthly report recounting significant activities, progress and follow-up needed Assess reimbursement environment (coverage, coding and payment) for any new products and procedures
  • Assists with the relationship and application processes with key federal and state agencies. This would include but not be limited to: influencing public and private insurance coverage decisions and outcomes and assuring appropriate coding for reimbursement of all components of care.
  • Drives the reimbursement for federal payer programs under Health & Human Services and Medicare (CMS) including 340b, Medicare/MAC, and Durable Medical Equipment Carriers (DMERC/DME MAC).
  • Develops and maintains key relationships and communicates with Medicare decision makers (i.e. Dir. of Ambulatory Services, Medicare Ombudsmen, Product Safeguard Contractors, and DME MAC to drive appropriate coverage decisions impacting CSL therapies.
  • Serving as a member of all new product launch teams, including supporting all components of reimbursement coding for new products and future modifications. Will support manager with all necessary applications to Federal and State payer programs including Medicare and Medicaid for all new product launches.
  • In conjunction with the training department develop and conduct reimbursement training and educational materials for CSL field based and as appropriate home office personnel. Works in conjunction with the filed based reimbursement specialist to develop and present reimbursement training materials for healthcare providers (Specialty Pharmacies, distributors, hospitals, physicians, etc.).
  • Monitor and oversee the updating of all product reimbursement guidelines (print and reimbursement web site).Maintain CSL Reimbursement web site to include: reimbursement-news alerts, Medical Coding updates (HCPCS, CPT, ICD10), and news releases from Medicare (CMS).
  • Develops and implements reimbursement strategies and programs to obtain coverage in a designated territory
  • Provides reimbursement-related advice to product development teams, marketing, sales, regulatory, clinical and business leaders
  • Identifies payer opportunities and implements programs to resolve/decrease barriers to entry for CSL products or therapies
  • Works closely with Health Economics and Outcomes Research staff to evaluate the economic impact of the use of therapies/products on payers, including the government
  • Develops and delivers educational workshops on reimbursement to healthcare providers (Specialty Pharmacies, distributors, hospitals, physicians, etc. Requires 50-60% domestic travel.
  • Bachelor degree in business/marketing or science discipline; MBA a plus
  • 7+ years' relevant commercial operations experience
  • Experience diagnosing and resolving complex issues
  • Knowledge of relevant legal, compliance and regulatory requirements
  • Proficiency with Microsoft Office; SAP experience preferred
Excellent understanding of private and public insurance policies. Prior reimbursement and or case management experience required. Strong understanding of Medicare Polices. Work experience with patient advocacy groups regarding coverage policies preferred.