Allergan Associate Director - Pricing and Reimbursement - Ophthalmic Surgical Device - Southeast US in Atlanta, Georgia

Associate Director - Pricing and Reimbursement - Ophthalmic Surgical Device - Southeast US

Atlanta, Georgia, United States at

▾ ▸ 2 additional locations

Charleston, South Carolina, United States Orlando, Florida, United States

Oct 17, 2016Post Date

150868Requisition #

Allergan markets a portfolio of best-in-class products that provide novel treatments for the central nervous system, eye care, medical aesthetics and dermatology, gastroenterology, women's health, urology, anti-infective and cardiovascular therapeutic categories. With commercial operations in approximately 100 countries, Allergan is committed to working with physicians, healthcare providers and patients to deliver innovative and meaningful treatments that help people around the world live longer, healthier lives.

Our success is powered by our world-class team’s commitment to being Bold for Life. Together, we build bridges, power ideas, act fast and drive results for our customers and patients around the world by always doing what it is right.

Join one of the world’s fastest growing pharmaceutical companies!

At Allergan you will have the opportunity to thrive in a fast-paced, strategic environment where bold, innovative thinking isn’t just welcomed, it’s encouraged. Across all functions, we relish the opportunity to help our people fulfill their potential. Our rapid growth strategy means plenty of opportunities to step into the spotlight.

Position Description

The Associate Director of Reimbursement and Pricing is responsible for the coordination and execution of product reimbursement and facility/practice operational support related to XEN ® : a best-in-class, minimally invasive, surgically implantable stent for the treatment of glaucoma. The role informs on appropriate Medicare, Medicaid, and commercial payer coverage and coding of XEN ® , and works directly with health system, value assessment committees, approval committees, hospital department personnel (including C-suite), ambulatory surgery centers (ASCs), ophthalmic surgeons, and office staff, in an assigned region.

The position is responsible for identifying Hospital and ASC facility access and purchasing channels and resolving facility related reimbursement and operational pull-through issues. Provides reimbursement-related support to ophthalmic surgeons, ASCs, and Hospitals on the adoption of XEN ® , and appropriately builds customer advocates, and executes facility and surgeon reimbursement and operational initiatives in support of the glaucoma brand team’s annual marketing plans.

The position works effectively and appropriately with key Allergan stakeholders across various business units in a heavily matrixed environment to achieve targeted results. The stakeholders include the glaucoma ophthalmic surgery sales and marketing teams, Payer Marketing, Managed Markets Field Managers and Directors (Medicare and Commercial Payers) XEN ® Reimbursement Solutions HUB services, and other Allergan divisions as necessitated by market environment.

The role is 70% field-based, with approximately 30% office planning, and requires approximately 50% overnight travel and occasional weekend work.

Hospital/Ambulatory Surgery Center Reimbursement Analysis

Develop and implement health economics and reimbursement activities for key administrative stakeholders. Facilitate Hospital & ASC payer contract analysis to provide understanding of appropriate XEN ® reimbursement. Develop and implement reimbursement strategies and economic value plans to support ophthalmic surgeons and facility customers by identifying opportunities to partner with hospitals and ASCs regarding the economics of Allergan’s technologies and programs. Develop and implement valuation assessment committee strategies that remove barriers for XEN ® . Provide hospital C-suite personnel with coding and payment methodologies and models to support XEN ® .

Government and Commercial Payer Interaction

Work closely with the Medicare and Commercial Payer managers and directors within Managed Markets and Payer Marketing by providing education and information to assist in the development/revision of coverage and payment policies to gain appropriate payer coverage for XEN ® . Maintain a thorough understanding of commercial payer medical benefit plans, and possess a working knowledge of Part A/B MACs. Provide strategic insight and appropriate involvement in the payer account planning process, and identify and develop advocates interested in working with payers in the development of coverage and patient access to XEN ®.

Reimbursement Support and Services

Execute in-depth XEN ® reimbursement support and services with Hospitals/ASCs/Surgeons. Deliver ad-hoc intervention or on-going involvement covering a portfolio of programs, tools and services to address XEN ® reimbursement concerns, issues and solutions. Coordinates comprehensive XEN ® reimbursement pull-through with the glaucoma ophthalmic surgery sales and marketing teams, Payer Marketing & Managed Markets field managers and directors. Provide consistent internal Allergan communication and external customer communication regarding XEN ® ’s overall reimbursement and access status. Maintain positive relationships with customers for potential advocacy involvement, and facilitate and manage customer utilization of XEN ® Reimbursement Solutions HUB services.


Education and Experience

  • Minimum of a Bachelor’s Degree or higher required. MBA or Advanced Degree is a plus

  • Minimum 5-7 years managed care/reimbursement management experience in the permanent, implantable/surgical device field.

  • Minimum 5-7 years of progressively advancing work experience in one or more of the following categories: service line administration, c-suite experience in hospital, surgical practice, payer setting, or prior industry health care economics experience.

  • Broad knowledge and experience in the Medical Device Industry.

  • Experience in health policy, health economics, medical device reimbursement, technology assessment, health care marketing, research, or regional sales/corporate accounts

  • Hospital c-suite or executive experience including working with managed care contracting personnel

  • Eye care experience a plus

  • Ability to travel up to 50% of time. Valid driver’s license.

Essential Skills and Abilities:

Reimbursement Competency

  • Demonstrated medical coding and reimbursement acumen

  • Deep understanding of coding/payment methodologies across public and private payers as it relates to hospital systems

  • Excellent working knowledge of CPT, ICD, HCPCS, APC, Revenue and Modifier coding; facility, Hospital and ASC and surgeon reimbursement

  • Demonstrated knowledge of the current hospital reimbursement environment including managed care contracts

  • Ability to perform contract analysis with ophthalmic surgeons, ASC and Hospital administration and value committees

  • Familiarity with HIPAA in accordance with regulatory compliance

Managed Care Competency

  • Demonstrated knowledge of third party payers (Medicare and Commercial) and case management process (benefit investigation, prior authorization, appeals, etc.)

  • Payer policy development and access experience

  • Account management experience in Commercial, Medicare, and MAC Channels

  • Understanding of medical/clinical research methods and publication interpretation and ability to use evidence to support value proposition

Customer Relations

  • Proven ability to provide outstanding customer support

  • Possess provider and payer relation experience with proven ability to establish strong working relationships with customers

  • Ability to support and balance multiple customers and multiple priorities

Business Acumen

  • Ability to adapt to new roles and changing environment both internally and externally

  • Leadership, communication and presentation skills

  • Strategic thinker with experience implementing programs outside of direct reporting relationships

  • Ability to collaboration working across a matrix organization with various stakeholders

  • Communication and ability to distill complex information into concise, impactful communications to both internal and external customers/stakeholders

  • Problem solving of highly complex issues, which requires critical assessment of potential impact on multiple interested parties

  • Experience working in a broader enterprise/cross-division business unit model

  • Ability to work in a highly matrixed and geographically diverse business environment

  • Ability to work within a team and as an individual contributor in a fast-paced, changing environment

  • Strong communication, organizational and interpersonal skills, with ability to work independently and as a team member