Reimbursement Manager

MTF Biologics; United States; Hybrid; USD 80,000 - 100,000; Full time

Job summary

A leading biotech company is seeking a Reimbursement Manager to oversee reimbursement support services for their product portfolio. The role involves leading customer education meetings, managing reimbursement inquiries, and analyzing payer coverage trends. Ideal candidates will have a Bachelor's Degree and 3-5 years of relevant experience in healthcare reimbursement or related fields. Strong presentation and problem-solving skills are essential. The position requires some travel and offers a dynamic work environment.

Qualifications

• 3-5 years of experience in healthcare reimbursement support services or health policy.
• Solid understanding of Medicare and Medicaid payment methodologies.
• Experience working with sales and marketing teams to support product launches.

Responsibilities

• Manage reimbursement support services for the product portfolio.
• Lead customer meetings for coding and reimbursement education.
• Analyze casework for payer coverage trends.

Skills

Strong presentation skills

Problem solving

Project/program management

MS Office proficiency

Education

Bachelor's Degree in Health Care Administration or related field

Job description

Reimbursement Manager

Reporting to the Senior Director of Health Policy and Government Affairs, the Reimbursement Manager will be responsible for the daily management of reimbursement support services of the product portfolio. The incumbent will act as the organization’s reimbursement liaison between sales staff and providers and must be willing to travel at least 30% of the time with some weekend travel required.

Responsibilities

• Support Senior Director of Health Policy and Government Affairs in fielding and responding to coding, coverage, and reimbursement internal inquiries and providing policy research assistance.
• In coordination with sales and marketing staff, lead on-site customer meetings (e.g. physicians & hospital medical professionals, purchasing & revenue departments, billing/coding staff) to provide coding and reimbursement education & assistance and address any reimbursement challenges.
• Manage third party reimbursement support services -- monitoring and analyzing casework for payer coverage trends and assisting with challenging cases and claims’ appeals.
• Create internal educational materials and customer collateral (coding and reimbursement guides, etc.).
• Prepare and submit Medicare Part B ASP data quarterly to CMS.

Minimum Qualifications

Education: Bachelor's Degree

Degree In: Health Care Administration, Public Health, Public Policy, Public Administration, Finance, Business, Marketing, Communications or related field

Years of Experience: 3 - 5 years.

• Minimum of 3-5 years of successful work experience in a related field e.g. tissue banking/tissue processing, medical device manufacturing, pharmaceutical or biologicals industry, healthcare reimbursement support services or health policy.
• Possess a solid understanding of the Medicare and Medicaid programs and their payment methodologies including coverage development, coding, and reimbursement of allografts (e.g., tissue matrices/skin substitutes, musculoskeletal tissues, etc.,) used in wound care as well as in plastic & reconstructive and orthopedic procedures in all sites of care (e.g. physician offices and hospital outpatient & inpatient, and ASC settings).
• Previous experience working with sales, marketing, clinical, regulatory, and research & development teams to support product launches and educate sales internal staff and external customers on current and future product coding and reimbursement.
• Track record of developing and delivering product value through presentations to varied audiences for products with limited payer coverage & reimbursement.

Preferred Licenses and/or Certifications: Certified Professional Coder (CPC), Certified Professional Biller (CPB), or Certified Billing and Coding Specialist (CBCS)

Specialized Knowledge, Technical Skills, and Abilities

• Experience with tissue matrices/skin substitutes used in wound care and surgical interventions as well as allografts used in plastic & reconstructive and orthopedic procedures.
• Able to work independently with demonstrated self-initiative, capacity to research and stay current on managed care and healthcare industry trends.
• Strong presentation skills with ability to articulate and present complex information in a simple and persuasive manner.
• Outstanding problem solving, project/program management and organizational skills.
• Demonstrated proficiency in MS Office (MS Word, Excel, PowerPoint, Outlook, etc.) software.