Objective:

The Regional Account Manage-Market Access (RAM) will execute the payor strategy within an assigned region to secure and maintain favorable coverage, coding, and reimbursement across commercial plans, Medicare Advantage (MedAdv), and Medicaid in assigned states. This role reports to the National Payor Account Director (East / West) and will drive access for Surgical Glaucoma products, influence payer policy, and enable provider adoption and patient access. This role will establish and maintain payor relationships, i.e., Medical Director and medical policy staff, resolving reimbursement barriers, and ensuring appropriate and consistent payment.

The RAM will also serve as a reimbursement liaison as needed and collaborate with cross-functional colleagues in Sales, Medical Affairs, and the HUB provider to educate physicians and institutional customers in local payor policy requirements. RAM-Glaucoma will serve as a subject-matter expert in regional payor policy for MIGS devices for medical benefit. The RAM will proactively engage with medical directors, state agencies, and advocacy groups in the assigned region to build sustainable coverage pathways and support future technologies B+L brings to the market. Extensive field engagement and travel required.

Responsibilities:

Develop and execute regional payor strategies to secure and maintain coverage, coding, and reimbursement across Commercial, Medicare Advantage and Medicaid as required.
Partner with Sales teams to educate and support customers by removing access barriers and resolve complex reimbursement challenges.
Conduct reimbursement seminars via videoconference or in person on local payor coverage criteria and requirements for appropriate reimbursement of B+L Surgical Glaucoma products.
Build and sustain relationships with payor medical directors, state agencies, and advocacy organizations to influence policy and coverage decisions.
Serve as the regional payor and reimbursement subject-matter expert for assigned payors - guiding internal teams and customers on medical device reimbursement, coding, billing, and appeals processes.
Understand and work with key health care stakeholders within the following customers: Commercial Managed Care (Regional Plans), Medicare Advantage (MedAdv), Medicaid (Fee for Service) as needed, State Ophthalmic Medical Groups, State Advocacy, patient, provider, and other key healthcare stakeholder groups.

Qualifications:

Bachelor's degree required, advanced degree in life science, business and ophthalmology experience preferred.

5 plus years of industry experience in payor/reimbursement roles within medical devices and Part B coverage
Minimum 2 years' experience in ophthalmic practice management, practice billing, and revenue cycle, public or private third-party reimbursement related to MIGS and their impact on providers, ASCs, and hospitals.
Ability to interpret MAC LCDs and Articles related to MIGS and seek enforcement of CMS regulations as they pertain to Medicare Advantage plans.
Proven experience with payor strategy, reimbursement, and account management; direct product launch experience highly desirable
Deep knowledge of Commercial, Medicare, and Medicaid reimbursement structures, coding (i.e., CPT, ICD-10 codes), billing, and appeals processes.
Strong executive presence and stakeholder engagement skills with payors, KOLs, hospital systems
Highly organized, self-directed, ability to work with ambiguity and effective in cross-functional environments.
Able to travel extensively (30% - 50% / ~ 3 nights/week)

For U.S. locations that require disclosure of compensation, the starting pay for this role is between $140,000.00 and $185,000.00. The estimated salary range reflects an anticipated range for this position. The actual base salary offered may depend on a variety of factors.

U.S. based employees may be eligible for short-term and/or long-term incentives. They may also be eligible to participate in medical, dental, vision insurance, disability and life insurance, a 401(k) plan and company match, a tuition reimbursement program (select degrees), company holidays, and well-being benefits, among others. U.S. based employees are also eligible to receive sick time, floating holidays and paid vacation.

Bausch & Lomb Incorporated

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