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The Senior Manager, Reimbursement position is responsible for securing new coding, positive medical coverage, and adequate payment within the US by engaging with government payors, and for monitoring and shaping health policy to support innovative products and market access solutions for targeted Chronic Care Coloplast products and services.
Job Responsibility:
Collaborates with the Director of Government Affairs, Reimbursement and Health Policy in the development and execution of US reimbursement strategies to fight commoditization of DMEPOS products by shaping national/local coverage decisions and payment methodologies, engaging various stakeholders to influence/petition payers with coding, coverage and payment consideration requests
Manage, communicate and execute US reimbursement strategies that ensure Coloplast Chronic Care Products have strong value propositions in the Durable Medical Equipment, Prosthetics, Orthotics & Supplies (DMEPOS) products categories
Partner with Public Affairs to develop campaigns and initiatives to engage stakeholders to petition government payers with coding, coverage and payment consideration requests
Partner with global and US cross-functional teams throughout product life cycles (product charter/program management, clinical studies and commercialization) to define evidence needs, develop and execute US reimbursement strategies and tactics that ensure Coloplast offerings have strong value propositions
Analyze and provide insight on health policy issues affecting Coloplast business: developing argumentation based on evidence and policy data analyses, and advocacy including comment letters designed to influence policy
Interpret clinical and economic evidence and articulate value proposition of Coloplast product, service and digital services to payers and health technology agencies
Develop and maintain a current knowledge of the government payors landscape within DMEPOS markets
Partner with Downstream Market Access and Comfort Medical teams to develop and deploy access and reimbursement solutions that support Coloplast growth strategies
Interpret health policy regulations and appropriately comment to minimize negative implications
Deliver and create clear and concise communications and presentations using approaches that highlight the most pertinent information for internal and external stakeholders that spur stakeholder action
Engage with government payors, physician champions, and professional societies articulating Coloplast’s unique value propositions to secure appropriate coverage, coding and payment policies for Coloplast technologies
Establish, execute and communicate government payor focused value messaging regarding Coloplast products
Monitor and communicate health policy changes to internal stakeholders
Maintain expert knowledge of government payor landscapes, trends, coverage issues, and payment methodologies pertinent to the Coloplast product lines particularly within DMEPOS
Coloplast employees are required to conduct business to the highest ethical and professional standards
comply with applicable laws and regulations, the MedTech Code of Conduct, and company policies
Other job duties as assigned
Requirements:
Illustrates a proven ability to operate within a cross functional MA team to develop public policy comments in response to the CMS annual calendar of rulemaking for DMEPOS, IPPS, OPPS & PFS
The ability to work independently with key stakeholders within a mulit-national company is highly desirable
Demonstrates a strong understanding of the "stage gate review process" within the pre-commercialization product development process
Demonstrates knowledge and experience working with reimbursement within the Medical Device industry, private (Health Plans/Employers) and/or public payors (Medicaid/Medicare) in policy, access and reimbursement issues required
Minimum 10 years’ experience working in the Medical Device, DME, managed care plan, Medicare/Medicaid arena
Demonstrated ability to work with organizational decision makers, including medical directors, hospital administrators, etc
Extensive knowledge of the various payment methodologies, CPT and HCPCS coding systems
Knowledge of managed care and/or insurance industry
Excellent written and verbal communication skills. Strong oral, written and presentation skills, experience building customer/payor facing power point presentations
Experience in the development of payer advocacy campaigns and documents describing the product, the comparators, market characteristics, clinical and economic evidence to support reimbursement and health technology assessment submissions
Proven ability to successfully execute strategies in a matrixed organization
Relationship building skills with global and US cross-functional internal and external audiences including physician customers, DME suppliers and/or payers or state-based government
Nice to have:
Master's level degree in health services research, epidemiology, public health, medical related field, or health economics
Ability to interpret clinical and economic evidence and articulate value proposition of Coloplast product, service and digital services to payers and health technology agencies
Experience presenting clinical and economic evidence and tools required
Hands-on experience partnering with payers at part of a hospital, clinical, Home Health agency, medical device manufacturer, DME suppliers
Successful track record with DPAC applications and negotiations around HCPCS code verifications
What we offer:
Comprehensive medical, dental, and vision insurance plans
Access to company sponsored wellness programs and mental health resources
Paid leave of absence for qualifying events
Generous paid parental leave for both birthing and non-birthing parents
Competitive 401(k) plan with company match that vest immediately
Financial planning services
Corporate discount programs for goods and services
Generous paid time off
Flexible work hours
Flexible work arrangement options
Opportunities for continuous learning and career advancement through training programs, mentorship, and tuition reimbursement
Recognition programs to celebrate achievements and contributions, including peer recognition, bonuses, awards, and special events
A supportive work environment
Team-building activities, volunteer opportunities, and company-sponsored events