Reimbursement Manager

Strategic Accounts

Job Summary:

The Reimbursement Manager (RM) helps minimize access and reimbursement barriers for providers to gain approval for Cerapedics’ patients they believe are appropriate candidates for i-FACTOR and ensure timely payment when utilizing Cerapedics’ products. As a member of the front-line field team, the RM is responsible for addressing access and reimbursement barriers by strategically collaborating with customers and accounts to solve patient access issues through all facets of the reimbursement cycle. The RM will provide education and support the integration of account implementation plans for Cerapedics’ products within sites-of-care. Additionally, the RM will analyze reimbursement and access issues and, in conjunction with the cross-functional Cerapedics’ team, act as the access and reimbursement expert for internal partners.

This position will work closely with field sales, marketing, and operations.

Specific Functions and Responsibilities:

  • Partner with internal and external stakeholders to identify, anticipate and address provider reimbursement issues; implement updates/changes based on solutions generated to address the issues
  • Identify payers and providers that require access and/or reimbursement education and support regarding Cerapedics’ products
  • Provide insights and updates regarding product and support service integration at accounts
  • Provide coverage, coding, and reimbursement information to key account staff members (i.e., practice manager, nursing, billing, and reimbursement staff) to appropriately support i-FACTOR approval and payment
  • Collaborate with Commercial and Medical Field teams to compliantly share insights into customer needs, potential access and reimbursement barriers, and payer coverage issues/opportunities impacting access at sites-of-care
  • Monitor payer coverage policies, communicate and explain payer coverage policies (and any changes impacting access positively or negatively) to internal and external customers in a timely manner, and track payer denials and support appeals process to secure approval for i-FACTOR
  • Proactively communicate i-FACTOR access and reimbursement services and appeal programs, policies, procedures, and resources so that customers are fluent in how to use programs and systems
  • Provide customer support associated with i-FACTOR coverage, access, and reimbursement from accounts in collaboration and coordination with cross-functional teams as directed by policy and procedure
  • Conduct quarterly reviews with facilities and providers on their utilization of Cerapedics reimbursement support services to better understand how we may evolve our offering to best suit the needs of the customer
  • Keep abreast of customer and market access industry trends

The above description outlines the most common job duties; however, it does not exclude other potential work assignments

Education or Formal Training Required:

  • 5+ years of commercial experience in the medical device, medical-benefit pharmaceutical, biotech or healthcare-related industry
  • 3+ years of experience with US payment systems and healthcare trends including reviewing commercial coverage policies and Medicare payment regulations (e.g., coding, billing, and reimbursement in various sites of care, including hospital inpatient and outpatient departments, and ambulatory surgical centers)
  • Orthopedics-related experience strongly preferred
  • Bachelor's degree from a four-year college or university

Qualifications Required: (knowledge, skills, abilities, initiative, judgment, etc.)

  • Shown expertise in supporting facilities and providers with coding, billing, and submissions across multiple payer channels (e.g., Medicare, Commercial payers)
  • Familiar with ICD-10, CPT, HCPCS, APC, and MS-DRG coding systems
  • Familiar with health insurance claim forms (e.g., CMS-1450, CMS-1500), explanation of benefits, and prior authorization forms to troubleshoot cases where billing, claims submission or documentation errors may occur
  • Able to analyze, interpret and understand regulatory and legislative payer and healthcare policies
  • Able to collaborate effectively across functions in a complex organization and environment
  • Able to apply effective communication techniques, engages in focused dialogue, and demonstrate good listening skills
  • Able to present to small and large groups and deal with unexpected questions and challenges while presenting
  • Able to develop logical cases that effectively influence collaboration, alignment, and execution across all levels of the organization
  • Able to identify themes and data to make strong recommendations to improve operations and patient and customer experiences
  • Advanced office software skills, particularly MS Excel and PowerPoint

Work Conditions / Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully preform the essential functions of the job. Reasonable accommodations may be made when requested by the employee to enable individuals with disabilities to perform the essential functions.

  • This position requires the incumbent to regularly utilize written and verbal communication skills, including active listening and speaking clearly and concisely.
  • This position requires the incumbent to experience periods of prolonged sitting and to occasionally stand, walk, carry items, climb, reach, and lift up to 20 lbs.
  • This position requires the incumbent to operate office equipment such as telephones, computers, fax machines, copiers, and to grasp objects utilizing manual dexterity including hand/finger coordination.

Travel Requirement: Approximately 30%

Benefits/Compensation (including but not limited to)

Medical and dental insurance, group life insurance, 401k matching, long term disability, potential target bonus, paid time off.

Salary Range: $110-125k

We're an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

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