Job Description Summary
We are looking to fill the role of a field-based Manager, Heath Economics & Reimbursement (West Region) position. This position will report directly to the Director, Health Economics & Reimbursement.
The Manager, Health Economics & Reimbursement position is a customer facing role responsible for assisting in the execution of health economic and reimbursement strategies of Halyard Health’s interventional pain management products. Key functions to include coding and payment analysis, health technology assessment, insurance authorization, coverage, and cost effectiveness analysis as well as building relationships with regional payers and targeted providers. Creates awareness among key healthcare decision makers and payers to ensure a favorable government and private reimbursement environment, improving acceptance and increasing adoption of Halyard’s interventional pain management devices and the procedures in which they are utilized.
- Assists with the execution of health economic and reimbursement strategies to ensure appropriate reimbursement of Halyard’s interventional pain management products from both government and private payer health care organizations
- Provides reimbursement expertise and analysis in support of Halyard’s products for external and internal customers for interventional pain products
- Leads discussions with financial decision makers in hospitals, ASC, and physician groups on the economics of Halyard’s interventional pain management products
- Develops and implements a focused payer and managed care plan based on key local and regional government and commercial payers
- Develops and manages a network of payer reimbursement contacts and data to assist in the research and tactical implementation of the payer plan
- Evaluates incoming requests from the field and ensures each request is properly evaluated for feasibility, technical risk, cost and time constraints, compliance, and other relevant considerations
- Provides insight and appropriate involvement in the sales/reimbursement process as well as identifies, develops, and maintains advocates to assist with payers for market access and coverage
- Provides health economic and reimbursement presentations to external and internal customers to assist with market access
- Assists in the development of reimbursement training programs
- Interacts with healthcare professionals and professional societies to support reimbursement initiatives
- Assists in the analysis and reporting on government policies and key commercial payers affecting reimbursement and/or patient access to Halyard’s products and develop recommendations to address resulting opportunities or challenges
- Other responsibilities as required/needed
- 20-50% travel - all domestic to corporate office, provider meetings, training sites, national/regional sales meetings, reimbursement conferences, and cadaver labs
- Bachelor’s degree required. Master’s degree highly preferred
- Minimum of 5 years of relevant medical device reimbursement experience (commercialization, health economics, coding/coverage, market access, healthcare policy)
- Experience in the pain market space as well as with minimally invasive devices a plus
- Experience with educational presentations to external and internal customers
- Excellent knowledge of CPT, ICD-10, HCPCS, APC, revenue and modifier coding; hospital inpatient/outpatient and ASC plus physician reimbursement across government and private payer environments
- Working knowledge of compliance and regulatory medical device environment
- Proven and broad experience in government and private payer reimbursement issues throughout the health care spectrum, including physician, inpatient and outpatient settings, critical access, home health, skilled nursing facility, and long term care
- Self-starter; ability to electively plan, prioritize, execute, follow-up and anticipate challenges without significant direction/oversight
- Must have strong analytical and prioritization skills with the ability to manage several projects simultaneously
- Ability to work collaboratively across multiple functions (sales, managed markets, marketing, etc.)
- Must be able to perform under pressure in a dynamic environment
- Must have a high degree of initiative, motivation, and passion for position and business
- Must be able to work, direct, and take direction with all levels of management
- Strong verbal, writing, and presentation skills. Public speaking includes (among others) presentations to the sales organization, healthcare professionals, government agencies, and health plans.
Halyard Health is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, sexual orientation, gender identity or any other characteristic protected by law.