Requisition ID: 7035Job Title: Field Reimbursement & Payer Relations Manager - RemoteJob Country: United States (US)Essential Duties and Responsibilities:This is a field-based role requiring the ability to travel >50%. The Field Reimbursement and Payer Relations Manager is part of the Market Access, Reimbursement, and Medical Policy (MA&R) team. The MA&R team supports internal and external customers navigate through reimbursement nuances and barriers, the facilitation of authorizations and appeals, and collaborates with key opinion leaders, Specialty Societies, Government organizations, and payer decision makers to influence coverage via policy change in efforts to increase access to Avanos products. This role will primarily focus on the Avanos Pain Management and Recovery product portfolios.
Key Responsibilities:- Delivers expert-level acumen on coding, billing, fee schedules, payment methodologies, revenue cycle management support to our customers.
- Works in partnership with customers to develop strategic and tactical direction to customers based on the reimbursement landscape.
- Provides superior support to customers to ensure accurate submission and adjudication of claims by translating medical policies, regulatory requirements, clinical coding guidelines, and business reviews in an accurate, consistent, timely, and compliant manner.
- Develop and execute strategies to secure and expand payer coverage for key company technologies and therapies.
- Monitor and analyze payer policies, reimbursement trends, and regulatory changes that impact business performance.
- Collaborate with cross-functional teams including clinical, regulatory, marketing, and commercial leadership to align reimbursement strategies with business objectives.
- Engage with payers and external stakeholders to communicate the clinical and economic value of company technologies.
- Support development of payer education materials, reimbursement tools, and policy submissions.
- Navigate the commercial payer landscape to prepare, develop, and deliver clinical and economic positioning designed to challenge, overturn, or influence payer policies affecting RFA technologies.
- Fosters a strong alliance with the MA&R Team in the identification applicable market access, reimbursement, and payer coverage changes and/or trends at the customer, regional, and national levels (e.g., CMS rules and updates, payer policies and reimbursement guidelines, and Society and Government initiatives) that may impact patient access to Avanos products. Partners in the development and pull-through of strategic initiatives in efforts to increase access and neutralize barriers to Avanos products.
- Collaborates with internal teams at tradeshows and events to provide reimbursement education, address reimbursement related concerns, promote our Patient Access Program, and collaborate in the identification of strong physician advocates to assist with efforts to obtain payer coverage.
- Establishes professional relationships and maintains an effective communication network with the internal and external customer at multiple levels.
- Recognizes internal and external customer needs/opportunities, KOL advocacy, payer coverage, Government initiatives (e.g., Capitol Hill), strategic opportunities, and pull-through initiatives and supports with the execution of strategies that align with department and company objectives.
- Demonstrates uncompromised ethics while helping others understand legal and regulatory parameters related to market access and reimbursement.
- Assists, when necessary, in the operations of the Avanos Patient Access Program; including but not limited to the collection of documentation in preparation and facilitation of prior authorizations and appeals in accordance with payer requirements as well as interpretation of payer determinations and patient appeal rights.
- Adheres to the Avanos Corporate Compliance programs and successfully participates in training and continuing education programs (internally and externally).
- Performs other duties and projects as required/needed.
Your qualificationsRequired:- Bachelor's degree required; advanced degree (MBA, MPH, MHA, or related field) preferred.
- 3+ years of experience in market access, reimbursement, payer relations, or healthcare policy within the medical device or healthcare industry.
- Strong understanding of payer policy development, coverage pathways, and reimbursement dynamics.
- Proven ability to collaborate cross-functionally with clinical, regulatory, commercial, and government affairs teams.
- Strong written and verbal communication skills, with the ability to translate complex clinical and reimbursement information into clear, compelling messages for internal and external stakeholders.
- Excellent analytical, problem-solving, and strategic thinking skills.
- Minimum of 2+ years of experience working within a commercial organization (e.g., sales, marketing, or commercial operations), supporting customer-facing teams and/or sales organizations.
- Minimum of 4 years' relevant market access and reimbursement experience (e.g., payer relations, policy change, product commercialization, health economics, coding, coverage, payment, work with Specialty Societies and Governmental entities, etc.) in efforts to remove reimbursement and patient access barriers within the industry.
Preferred: - Certification and/or Degree in medical coding or billing with a demonstrated level of reimbursement competencies including but not limited to CPT, ICD-10, HCPCS coding, modifier use, billing processes and guidelines, claims adjudication processes, EOB interpretation, and revenue cycle management across government and private payer environments.
- Comprehensive understanding of market access for government and private payers with an advanced ability to locate and interpret payer coverage policies, requirements for coverage, payment methodologies, and the pre-and post-service review processes and requirements. As well as experience submitting policy change requests and working with payer medical policy decision makers.
- Exceptional ability to provide superior support and education to customers and to expertly navigate through challenging situations.
- Collaborative work ethic and a strong skillset in project/strategic pull-through, time management, and communication (verbal and written) skills.
- Proficient in Microsoft Office applications. Experience with data visualization software (e.g., Tableau) and CRM applications (e.g., Salesforce.com) or the aptitude to learn such tools.
- Competent understanding of the compliance rules and regulations applicable to market access and reimbursement in medical/technology environments (e.g. HIPAA, Federal Statutes).
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 $135,000.00 - $157,000.00. 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.
Avanos offers a generous 401(k) employer match of 100% of each pretax dollar you contribute on the first 4% and 50% of the next 2% of pay contributed with immediate vesting.
Avanos also offers the following:
benefits on day 1
free onsite gym
onsite cafeteria
HQ region voted 'best place to live' by USA Today
uncapped sales commissions
