Summary of  Purpose:      To support RxCrossroads management, reimbursement program teams, and clients through ongoing analysis of existing and proposed changes in state and federal policies affecting reimbursement, billing and coding in all practice sites (inpatient, outpatient, home care) for specialty prescription drugs and devices.  The Healthcare Policy and Payer Relations may also work as a liaison between managed care organizations and our pharmaceutical clients to educate on our client’s products and to research reimbursement irregularities and nuances.  This position will be the primary point of contact to provide services and communications to our client’s and RxCrossroads product support teams.

Duties and Responsibilities (Essential Functions):

• Monitor new emerging policies affecting client’s products reimbursement.
• Monitor and review the payment policies that are important for our client’s products and procedures related to treatment with these drugs.
• Advise RxCrossroads management and reimbursement program teams regarding reimbursement trends including the analysis of existing and proposed changes in state, federal, or private insurance policies affecting health care reimbursement.
• Formulate and conduct training of management and staff on the reimbursement environment in all practice settings and recent changes in state or federal legislation affecting health care and drug reimbursement policies.
• Contribute to the development of reimbursement strategies for client support services.
• Participate in the negotiations of in-network provider contracts for RxCrossroads pharmacy.
• Advise RxCrossroads management regarding reimbursement fraud and abuse issues including development of internal policies and procedures designed to comply with regulations.
• Provide guidance and assistance to foster, enhance and maintain reimbursement relationships with important government agencies and private payers. 
• Obtain and seek to influence payers’ clarification on coding, coverage and payment issues, including submitting clinical and econonomic information to obtain important supportive authoritative documentation and clarification for the pharma client sales force and customers.
• Assist pharma client with all aspects of local and national payer issues.  Facilitate written and verbal communications and meetings with payers, and prepare participants for discussions and negotiations.
• Investigate and review Local Medical Policies (LMRP) and national coverage policies that affect our client’s products. 
• Research, design and provide content for coding and reimbursement education materials, such as brochures and seminars, for sales force and customer use.  Working closely with the pharma client brand and marketing teams, the Healthcare Policy and Payer Relations identifies, provides authoritative documentation and develops reimbursement content and materials for all pharma client reimbursement publication needs with regards to disease states the client’s products treat and their products, including marketing materials, Web sites, e-mail notifications, fax alerts, newsletters, FAQ’s PowerPoint presentations, guidance documents, brochures, CDs, etc.
• Provide the capability of an expert presenter or written materials and authoritative documentation for pharma client’s payer or reimbursement staff for ongoing reimbursement activities or during special events such as launch of a new product or a yearly or local sales team meeting.  The Healthcare Policy and Payer Relations can offer assistance for educational presentations on site (face to face), or via conference call.