Requisition ID: 6896

Job Title: Associate Director, Market Access & Reimbursement - Alpharetta, GA or Remote

Job Country: United States (US)

Essential Duties and Responsibilities:

The Associate Director of Market Access, Reimbursement, and Medical Policy is a customer-facing role responsible for developing and implementing U.S. reimbursement strategies that affect current and future products across Avanos' Specialty Nutrition Systems and Pain Management portfolios. The position will work closely with the business units to drive and develop market access initiatives that support Avanos's priorities

Key responsibilities include coding and payment analysis across various settings (Physician, Hospital Outpatient, and ASC); insurance coverage, prior authorization, and appeals support; and cost-effectiveness evaluations. The role collaborates on reimbursement methodologies across both government payers (e.g., Medicare, Medicaid) and commercial insurers, including analysis of procedures, services, and durable medical equipment (DME).

20-40% travel. Prefer relocation to Alpharetta GA although not required.

Purpose of the Position:

• Develops strategies to optimize the reimbursement landscape to include coding, payment, and coverage from third-party payers, CMS/other government payers, and healthcare customers for Avanos Medical's entire product portfolio, including key brands such as MIC-KEY*, ON-Q*, ambIT*, GAME READY*, and Interventional pain (IVP) management products [TRIDENT* and COOLIEF* cooled radiofrequency technology], etc.
• Manages the national Market Access, Reimbursement, and Health Policy teams with multiple direct reports
• Leads efforts to directly market payment/reimbursement opportunities and market access value propositions with payers, providers, and value analysis committees to drive sales growth.
• Develops critical relationships with physicians and payers to drive appropriate clinical utilization on medically necessary patients and, therefore, sales of product/s.
• Supports commercial reimbursement initiatives in collaboration with Sales and Marketing, working closely with Clinical Affairs.

Key Responsibilities:

• Manages and leads the national Market Access Reimbursement and Health Policy team with multiple direct reports.
• Recruits, develops, and leads the performance of employee(s) to develop programs aligned with market access, reimbursement, and health policy.
• Leads the market access /reimbursement and health policy teams in developing and regularly updating reimbursement and health policy tools for use with sales, physicians, facilities, and payers.
• Establishes goals aligned with Avanos' organizational plans and strategic imperatives, driving execution through mentoring and leadership. Develop Avanos' national payer strategy to market the value proposition of products directly to payers to secure favorable product reimbursement.
• Provides strategic expertise to Sales and Marketing to develop and execute plans that drive revenue growth and reach appropriate patient populations. Collaborate with clinical functions on evidence generation strategy and needs to support market access and company goals.
• Monitors and analyzes changes in the external reimbursement environment, assesses associated risks and opportunities, and communicates portfolio impacts with recommended action plans. Develop and manage reimbursement collateral, tools, communications, and content development to drive sales growth for appropriate patients.
• Educate internal teams on market access topics and reimbursement changes; deliver through training programs and field sales engagement to properly educate customers on the benefits of Avanos products for appropriate medically necessary patients.
• Develop critical relationships with physicians and payers to adopt clinical utilization of IVP (TRIDENT* & COOLIEF*), ambIT*, ON-Q*, GAME READY and enteral feeding products.
• Builds and formulates collaborative relationships with Avanos functional departments and serves as a liaison to external stakeholders.
• Drive facility and provider network development by providing market access, reimbursement, and medical policy expertise to executive teams of health care systems, hospitals, physicians, independent, joint-venture, and ASC management companies.
• Influence appropriate government agencies and health care payers to obtain appropriate coding, coverage, and payment.
• Interact with the American Medical Association and CMS to obtain coding and coverage for new modalities/procedures and product codes
• Provide expertise on state and federal regulations for reimbursement methodologies and appropriate coding for SNS and Pain Management products.
• Manages and directs the monitoring of third-party resources and data that may be utilized to drive the creation of analyses.
• Serves as the internal and external subject matter expert on market access, reimbursement, and medical policy matters for SNS and Pain Management products. Integrates health economics considerations into reimbursement and market access strategies to support sustainable patient access.
• Complies with U.S. Food and Drug Administration (FDA) regulations, other regulatory requirements, company policies, operating procedures, processes, and task assignments.
• Maintains clear, effective communication and positive, cooperative collaboration with internal and external stakeholders at all organizational levels. Supports budget management and planning for department program spend.
• Performs other related duties and responsibilities as requested

Reporting Relationships:

Direct report to the Vice President, Global Marketing

Current positions reporting to this leader include Field Reimbursement Manager(s), Payor Engagement Manager with dotted line leadership responsibility to two Reimbursement Patient Access Specialist/ Manager.

External Interface:

Health Insurers, both government and commercial, third-party billing companies, current and potential customers, Industry Trade Associations, KOLs, professional medical societies, CMS, and US governmental agencies

Internal Interface:

All business groups within the organization

Qualifications:

Required:

• Bachelor's degree required.
• 10+ years of medical device reimbursement, including DME, third-party billing experience, and strategic marketing experience.
• Medical device industry experience required.
• Broad-based knowledge in medical device and DME market access, reimbursement, patient access, payer coverage policy, employee management, business management, project management, marketing, and extensive experience in general health care.
• Demonstrated clinical acumen through interface with various physicians.
• Ability to drive appropriate payment coverage of products by payers.
• Strong communication, interpersonal, and analytical skills.
• Proficient in use of Microsoft PowerPoint, Excel, Windows, and Microsoft Office.
• Experience with data visualization software (e.g., Tableau) and CRM applications (e.g., Salesforce.com), or aptitude to learn such tools.
• General ability to learn and acclimate to new systems.
• Excellent leadership qualities.
• Persuasive, self-driven and motivated.
• Strong analytical and presentation skills, innovative and resourceful.

Preferred:

• MBA desirable

The statements above are intended to describe the general nature and level of work performed by employees assigned to this classification. Statements are not intended to be construed as an exhaustive list of all duties, responsibilities and skills required for this position.

Salary Range:

The anticipated average base pay range for this position is $160,000.00 - $185,000.00. In addition, this role is eligible for an attractive incentive compensation program and benefits. In specific locations, the pay range may vary from the base posted.

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