Associate Director, Field Reimbursement - iovera​/Zilretta North

Overview

Associate Director, Field Reimbursement - iovera/Zilretta North Central is a role at Pacira Bio Sciences, Inc. This is a customer-facing position reporting to the Senior Director of Market Access & Reimbursement, responsible for managing defined accounts within a specified region in the Non-Opioid Pain Therapeutic area. This role supports a specialty buy-and-bill therapy by driving product reimbursement and coverage, removing access barriers, and partnering with internal and external stakeholders to execute strategic plans.

The responsibilities include representing Pacira and the value of its products, facilitating understanding of reimbursement services, building relationships with key healthcare influencers, and serving as the internal expert on medical coding, billing, and reimbursement.

• Act as an extension of EXPAREL, provide live one-on-one coverage support.
• Offer assistance from physician order to reimbursement, supporting the entire Reimbursement journey through payer prior authorization to appeals/denials requirements procedures and forms.
• Review patient-specific information in cases where the site has specifically requested assistance in resolving any issues or coverage challenges.
• Review patient insurance benefit options
• Coordinating with Pacira’s patient support services programs representatives.
• Educating physician office staff on the use of Pacira’s call center support services, including web-based provider programs.
• Provide information on relevant Reimbursement topics related to Pacira’s portfolio.
• Serve as payer expert for defined geography and able to communicate changes to key stakeholders in a timely manner.
• Provide office support in accurate coding and billing for Pacira’s portfolio.

This position will not have supervisory responsibilities.

The incumbent will work closely with internal departments, such as Marketing, Field Sales, National Accounts, Clinical Education, Medical Affairs, HEOR and Corporate Communications/Advocacy, as well as with external constituents such as commercial or government payers, various associations and its members and third-party payer/employer consulting organizations.

• Bachelor’s degree from an accredited college or university in Health Policy, Finance, Business, or other related fields.
• Minimum of 6+ years related experience in the healthcare industry.
• Minimum of 3 years of relevant reimbursement experience, particularly managing targeted reimbursement relationships.

• General payer policy knowledge including managed care and Medicare/Medicaid
• Foundational knowledge of benefit verifications and prior authorization requirements
• Knowledge of Reimbursement and billing processes within the physician office
• Ability to review clinical information in patient charts, understand and interpret payer policy to provide guidance to HCP offices on how they may proceed in filling out prior authorization/formulary exception/appeals documentation.
• Specific knowledge of specialty product buy and bill, coding, and in office best practices on program management.
• Proven track record overseeing or managing medical billing and coding including appeals, denials, and single case rates.
• Excellent written and verbal English communication skills including presentation skills to groups of all sizes and at executive levels.
• Demonstrated ability to partner, communicate, and accomplish goals across organization without direct reporting structure.
• Proven ability to think strategically and succeed with limited structure and direction.
• Proven problem-solving, analytic and negotiation skills with high value contracts and partnerships.
• Extensive, proven reimbursement experience
• Demonstrated understanding of CMS, Commercial payment models and trends.
• Valid driver’s license in the state in which you reside.

While performing the duties of this job, the employee is regularly required to sit, talk, move between spaces, reach with hands and arms, and stoop. Close vision and the need to focus on computer screen, use of hands, fingers, and wrist to type on keyboard…