Reimbursement Manager and Senior Specialist

Two (2) Openings - National Reimbursement Manager

Two (2) Openings - Senior Reimbursement Specialist



Our client, a Successful and Entreprenurial, Fast-paced Medical Device company with over 3000 products, has New Openings for 2 National Reimbursement Managers over specific product lines (located anywhere in US or in MA-near Boston) And 2 Senior Reimbursement Specialists for specific products (must be located in southern MA).

 

The Reimbursement Manager will define, develop and lead implementation of coverage and payment strategies that increase market for medical device products.  Provide leadership in national strategic reimbursement planning, including supporting reimbursement policy efforts, strategic reimbursement plans to support business objectives and communication of reimbursement information to internal and external customers.  Work with field reimbursement organization to ensure coverage, coding and reimbursement policies are accurately applied.  Performance of this position is measured by the degree to which “reimbursement issues� are an impediment to metabolic surgical procedures.

 WEEKLY ACTIVITIES

 

·         Manage national, regional, state and employer policy and reimbursement dynamics.

·         Develop strategies to address strategic regional reimbursement plans.

·         Coordinate regional initiatives on policy, coding, and reimbursement issues.

·         Ensure effective implementation of regional reimbursement tactics.

·         Champion the evidence to support the value of metabolic surgical procedures.

·         Presenting reimbursement issues to national and regional payers.

·         Work with appropriate outside resources on special projects as needed.

·         Maintain understanding of reimbursement issues and disseminate best practices with other regions.

·         Maintain expertise in healthcare policy issues nationally, regionally and locally.

·         Perform other duties as may be required by supervisor. Educating Reimbursement team on reimbursement topics and progress. Educating Sales team on reimbursement topics and progress. Travel up to 50%. MINIMUM REQUIREMENTS AND QUALIFICATIONS

 

·         BS Degree a must, Prefer Advanced Degree in business/health care.

·         Minimum 6 to 9 years related work experience.

·         Prior experience in reimbursement planning or policy, coding and reimbursement. Including HCPCS and/or CPT coding, application experience either applying for a new code or working with current codes for a new product.

·         Medicare and/or Medicaid policy experience.

·         Prior experience with implantable devices or pharmaceutical industry.

·         Successful track record of working with sales team.

·         Strong Communication and organization skills a must.

·         Microsoft Excel, Word, Access, and PowerPoint.

The Global Senior Reimbursement Specialist:  Must be located in Southern MA.

 

The role of the Senior Product Reimbursement Specialist is to collaborate with internal (marketing, sales, government affairs, clinical affairs and healthcare economics) and external (clinicians, trade associations and the payer community) customers to develop and implement strategies which operationalize the economic value and business objectives to obtain the appropriate reimbursement (coverage, coding, and payment or equivalent in each country) for moist and active wound care technologies and therapies through their entire life cycle (initiation of product concept to product harvest). The key responsibilities to achieving this objective are: -Support the development and implementation of product reimbursement strategies for moist and active wound care technologies in all phases of the life cycle (pre-concept, acquisition evaluation, Product development process and post market launch). -Develop and maintain relationships with the host of payers (commercial, third party, and government entities), hospitals, physicians, patients and professional societies. -Interpret existing government policy as to its impact on existing products and business models. -Work with government affairs and trade associations to influence the development of new policy to enhance the position of our products. -Maintain current knowledge of the reimbursement landscape within the US market. -Serve as technical expert, in government reimbursement policies and areas of third party reimbursement, and a source for reimbursement information for internal (marketing, sales, Health Care Economics, clinical affairs) and external (customers, payers, trade associations) customers.

 

REQUIREMENTS:

Bachelor degree from a four year accredited college; or equivalent reimbursement experience Self-starter with a minimum of 5 years, 7 years preferred, proven healthcare coding, coverage and reimbursement experience with medical devices, wound care products, minimally invasive and/or health policy reimbursement matters Proven track record of successfully leading an organization through the strategic reimbursememt process and creating a change in coding/reimbursement for novel medical devices. Experience working with product management and R&D to ensure that a new product's reimbursement strategy is incorporated into the product development plan and business strategy in the concept stage and is appropriately refined throughout the product development cycle. Proven expertise in medical coding, billing processes and claim submissions to public and private insurers. Previous experience of primary responsibility of working with billing and medical claims personnel in various health care settings including, but not limited to a physicians office, hospitals, Ambulatory Surgery Centers, Skilled Nursing Facilities, and Home Health Agencies as well as sales personnel Excellent written and verbal communication skills