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December 30, 2008
Director of Reimbursement
Location: Madison, New Jersey, USA
Health Economics and Reimbursement is responsible for development and communication of the “value proposition” to ensure optimized coverage and reimbursements for products and procedures in which our products are used. The Director, Reimbursements will build, develop and lead a best-in-class Reimbursement Strategy function that delivers valuable programs and tools while establishing a long-term competitive advantage. The Director works with health economics/outcomes research, clinical research, government affairs and business unit marketing and finance teams, including New Product Development to develop government reimbursement strategies and programs specific to the marketplace.
The Director of Reimbursements also works with the payer community on a national level (Medicare, Medicaid, as well as private payers) and with key stakeholders in the medical community to guide implementation of externally focused strategies and programs. This includes programs for education of customers regarding the value of products.
Primary responsibilities include assessing government reimbursement environment (Coverage, coding, payment) and designing and implementing reimbursement and communication strategies to proactively leverage data to negotiate favorable policies with public (Medicare, Medicaid) and private (managed care) payers. This includes analyzing the impact of potential reimbursement changes to current and future markets and assessing the reimbursement opportunities and challenges for new product or licensing and acquisition targets. Works closely with Government Affairs to effectively influence positive public policy and reimbursement decisions. Develop and implement strategic programs to educate customers about the value of products, including coding conventions.
Establish and maintain appropriate and compliant communication linkages with customers (web tools, updates, seminars, hotlines, etc.). Provide education and consultation to internal business partners on reimbursement and public policy issues. Excel at environmental scanning and interpretation to find opportunities to improve technology adoption and acceptance. This may include active involvement with technology assessment groups (AHRG, NCQA, JCAHO, professional societies, AdvaMed, or other stakeholders or governmental organizations). Assist with development and review of marketing or medical/government affairs materials related to reimbursement and policy as requested.
Responsible for management and development of Reimbursements staff, if applicable.
Required knowledge
- Must have good understanding of clinical data and outcomes research and ability to integrate into business communications.
- Detailed knowledge of Medicare payment methodologies (coding, coverage, payment, both inpatient DRGs and outpatients OPPS), and payer and hospital technology decision processes required.
- Exceptional written and verbal communication skills.
Required experience:
- Bachelor’s degree required (business or science degree preferred)
- 8 plus years of relevant experience needed.
- Proven track record of excellence in presentation of complex materials.
- Must have proven track record of effective working relationships with payer customers and decision-makers (private and public). Government payer relations experience is needed.
- Strategic thinking with a bias for actions/implementation.
- Strong collaborative style, both internally and externally to build consensus and achieve objectives.
- Previous experience with management and development of employees strongly preferred.
This position may require up to 60% travel, primarily domestic.
Interested candidates should contact Steve Horner at Shorner@devonconsulting.com
