Market Access & Reimbursement Manager

The Market Access and Reimbursement Manager is responsible for executing the GYN surgical market access business plan. Duties of the MARM include but are not limited to, developing and maintaining relationships with key decision-makers within the regional commercial payers, state health associations, and other relevant organizations. The MARM influences policy decisions, fee schedules, product coverage, utilization management, and reimbursement payment decisions within assigned government and commercial payers. Account interface will be a key focus as the MARM has additional responsibilities to ensure both providers and facilities are educated on payer and reimbursement policies and procedures, as well as providing expertise on product economics and patient support services. The MARM is responsible for uncovering and addressing specific issues that may prevent or slow a patient’s access.

Essential Duties and Responsibilities may include all or some of the following:

· The MARM will implement strategies that achieve Business Unit and Corporate goals and objectives.

· Analyze data and develop strategy.

· Educate and enhance awareness of patient access services and programs.

· Educate and ensure providers understand payer prior authorization requirements, appeals process, clinical criteria, and appropriate coding information.

· Demonstrate deep knowledge in reimbursement and access across many patient support programs and be the subject matter expert in geography.

· Ensure timely follow-up that demonstrates urgency to the account and the patient.

· Collaborate and coordinate with regional sales teams to develop payer and reimbursement action plans for key provider accounts.

· Monitor, document, and communicate coverage policy changes and impacts to stakeholders.

· Collaborate with internal and external partners to maintain a payer coverage and reimbursement database and communicate changes to field sales and sales management teams.

· Collaborates with Managed Markets to educate customers surrounding Commercial Payers, State Medicaid Agencies, Managed Medicaid Organizations, Healthcare Maintenance Organizations, Health Care Plans, GPOs, DOD and VA, Integrated Service Networks, and other strategic healthcare entities specific to assigned initiatives and product requirements.

Candidate Requirements:

· BA/BS Degree and 5-7 years of pharma, biopharmaceutical, and/or medical device experience calling on field-based customers with a demonstrated successful track record.

· Minimum of 2 years of experience in a reimbursement or market access role preferred.

· Extensive knowledge of coding, coverage, and reimbursement.

· Understanding of commercial and government payer process (e.g., Medicaid FFS, Managed Medicaid, Medicare).

· Proven understanding of reimbursement methodologies by site of care (e.g., hospital outpatient, ASC, physician’s office).

· Experience working with billing and medical claims personnel in healthcare settings preferred.

· Excellent analytical skills, focusing on patients and customers, uncovering business opportunities, and identifying trends and solutions.

· Ability to condense and communicate complex reimbursement issues into simple solutions.

· Proven ability to thrive independently and within a collaborative cross-functional team.

· Experience building a team atmosphere with sales representatives with direct or indirect leadership authority.

· Ability to travel up to 25% including overnights for company and customer meetings