Overview:
This position is tasked with formulating the comprehensive strategy for the company's Reimbursement and Market Access for its medical devices, engaging with both internal teams and external partners. The role involves coordinating with various departments to implement tactics that highlight the value and clinical benefits of the company's medical devices, particularly to payers. Building and nurturing relationships, both internally and externally, is crucial for advancing the company's medical device initiatives.
Primary Responsibilities:
- Develop and implement strategies and tactics to optimize coverage by collaborating with internal and external partners to effectively present existing evidence and data.
- Identify clinical and evidence gaps related to new coverage requirements for the company's medical devices.
- Work with clinical and medical teams to identify opportunities to create additional value materials.
- Guide clinical teams to ensure evidence generation activities and clinical studies align with broader market access and reimbursement goals.
- Ensure the organization can effectively communicate the medical device value proposition to payers, understanding current reimbursement methodologies and recommending necessary changes for optimal patient access.
- Identify and address obstacles related to Coding, Coverage, and Reimbursement that hinder patient access to the company's medical devices, working cross-functionally to remove these barriers.
- Collect feedback from external partners to understand the real-world impact and considerations.
- Collaborate with field-based teams to gather ongoing insights on market dynamics affecting medical device reimbursement and coverage.
- Translate insights from customers, payers, and societies into actionable plans that shape value messages and tool development, including value dossiers, briefs, and economic models.
- Partner with Insights & Analytics to stay updated on key demographic, financial, and market access trends impacting medical devices, access, and reimbursement.
- Identify and pursue opportunities to collaborate with payers.
- Build relationships with key medical societies that influence treatment guidelines and understand how these guidelines affect payer decisions.
- Work with associations, third-party consultants, and other payer and provider networks to educate the payer community. Build and manage relationships with high-level influencers among national and regional payers and their networks, including ACOs, ASC Chains, HOPDs, and targeted consulting groups.
- Provide input and collaborate closely with marketing and field teams on product value propositions and outcomes needed to support reimbursement and market access for the company's medical devices and procedures.
- Coordinate with marketing and other functions on developing and overseeing reimbursement tools and support programs, including digital, social, collateral, support, customer hotlines, and educational programs.
- Serve as a resource for developing and communicating HEMA/HEOR-related materials and data to the field and customers.
- Work closely with internal partners on pull-through opportunities with payer customers, providing the necessary messaging and resources to maximize patient access.
- Partner with field teams to drive market access activities and tactics, including executing strategies to optimize market access, reimbursement, and commercial success.
- Collaborate closely with Market Access, Strategic Customer, and National Accounts teams to ensure mutual understanding of requirements and provide necessary data, collaterals, and programs.
- Act as the internal expert on medical device reimbursement.
Qualifications:
- Proven strategic thinking ability and success with indirect influence and independent direction.
- Current and relevant relationships with executive-level decision-makers at payers, societies, associations, and coalitions.
- Deep understanding of key payer processes and medical policies.
- Demonstrated knowledge of CMS and commercial payment models and trends.
- Understanding of medical billing, coding, appeals, denials, and single case/procedure rates.
- Proven ability to partner, communicate, and achieve goals across an organization.
- Strong problem-solving, analytical, and negotiation skills with high-value contacts and partnerships.
- Excellent written and verbal English communication skills, including presentation skills to groups of all sizes at executive levels.
- Ability to travel 50% or more.
Education & Additional Experience:
- Bachelor’s degree required; a background in Health Policy, Finance, Business, or a related field is a plus.
- At least 8 years of related experience in the healthcare industry.
- Minimum of 5 years of relevant experience in reimbursement, market access, or payer relations.
- Experience in taking medical device coverage from strategy development to execution and value creation in a dynamic organization.
- Strong understanding of the US market, medical delivery systems, reimbursement, market access conditions, and health policy trends affecting medical device and procedural coverage in the US.
- Solid knowledge of the evidence needed to drive favorable US reimbursement and market access for medical devices.
