Jobs

    Director of Market Access, Reimbursement and Medical Policy - Alpharetta, United States - Avanos Medical

    Avanos Medical
    Avanos Medical Alpharetta, United States

    4 weeks ago

    Default job background
    Description
    Requisition ID:5847


    Job Title:
    Director of Market Access, Reimbursement and Medical Policy


    Job Country:
    United States (US)

    Here at Avanos Medical, we passionately believe in three things:

    Making a difference in our products, services and offers, never ceasing to fight for groundbreaking solutions in everything we do;

    Making a difference in how we work and collaborate, constantly nurturing our nimble culture of innovation;


    Having an impact on the healthcare challenges we all face, and the lives of people and communities around the world.


    At Avanos you will find an environment that strives to be independent and different, one that supports and inspires you to excel and to help change what medical devices can deliver, now and in the future.

    The Avanos

    COVID-19

    Vaccine Policy:
    This Policy applies to U.S. customer-facing / field-based employees & Avanos leadership: All U.S. customer-facing / field-based employees hires must be fully vaccinated against COVID-19.

    Proof of being fully vaccinated does not need to be disclosed until a job offer has been made but must be submitted within 48 hours after the acceptance of the job offer.

    If you have a qualifying medical condition or sincerely held religious belief or practice that precludes you from receiving a COVID-19 vaccine, you may apply for an exemption or deferral after you accept the job offer and before your scheduled start date.

    The reasonable accommodation provided to the employee, if any, will depend on the employee's job and the applicable facts, but it may include weekly COVID-19 testing and masking requirements.

    New hires who do not submit, before their scheduled start date, proof of being fully vaccinated or a request for a reasonable accommodation will have their job offer revoked.


    Avanos is a medical device company focused on delivering clinically superior breakthrough solutions that will help patients get back to the things that matter.

    We are committed to creating the next generation of innovative healthcare solutions which will address our most important healthcare needs, such as reducing the use of opioids while helping patients move from surgery to recovery.

    Headquartered in Alpharetta, Georgia, we develop, manufacture and market recognized brands in more than 90 countries. Avanos Medical is traded on the New York Stock Exchange under the ticker symbol AVNS. For more information, visit .

    Department

    Health Economics and Reimbursement

    Position

    Director of Market Access, Reimbursement and Medical Policy

    Job Position Purpose / Summary


    Customer facing role responsible for assisting in the execution of health economic and reimbursement strategies of Avanos' interventional pain management products.

    Key functions to include coding and payment analysis, insurance authorization, coverage and cost effectiveness analysis as well as collaborating/building relationships with internal and external customers.

    Location

    Remote, Hybrid or Onsite


    Purpose of the Position:


    Creates strategies to obtain/optimize payment and coverage from third-party payers, CMS/other government payers, and healthcare customers for Avanos Medical's product portfolio including MIC-KEY, ON-Q, AMBIT and Interventional pain (IVP) management products [TRIDENT and COOLIEF cooled radiofrequency technology].

    Manages the national Market Access, Reimbursement, and Health Policy teams.

    Leads efforts to directly market payment/reimbursement opportunities and market access value propositions with payers, providers and value analysis committees to drive sales growth.

    Develop critical relationships with physicians and payers to drive appropriate clinical utilization on medically necessary patients and, therefore, sales of IVP product/s.

    Responsibilities (fundamental job duties):

    Manages the national Market Access Reimbursement and Health Policy teams.


    Recruits, develops, leads the performance of employee(s) to develop the program 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.

    Sets goals which align to Avanos' organizational plans and manages the execution of goals through mentoring.


    Develop the Avanos national payer strategy to market the value proposition of products directly to payers to secure favorable product reimbursement.


    Leads efforts to directly market payment/reimbursement opportunities and healthcare economic value propositions with payers, providers and value analysis committees to drive sales growth.

    Provide strategic expertise to sales and marketing to develop and implement plans to achieve sales/revenue objectives.

    Develop critical relationships with physicians and payers to adopt clinical utilization of IVP (TRIDENT & COOLIEF), AMBIT, ON-Q and MIC-KEY products

    Builds and formulates collaborative relationships with Avanos functional departments and serve 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, independent, joint-venture and ASC management companies.


    Mentor professional education and sales teams to properly educate customers on the benefits of Avanos products on appropriate medically necessary patients.

    Influence appropriate government agencies and health care payers to obtain appropriate 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 IVP products.


    Manages and directs the monitoring of third-party resources and data that may be utilized to drive the creation of analyses.


    Monitors, interprets, and summarizes changes in the external environment (regulatory/reimbursement changes, managed care arrangements, etc.) produces internal communication strategies on threats and opportunities with suggested action plans to IVP products.


    Is the internal and external subject matter expert on market access, reimbursement and medical policy matters related to Interventional Pain products.

    Complies with U.S. Food and Drug Administration (FDA) regulations, other regulatory requirements, company policies, operating procedures, processes, and task assignments.

    Maintains positive and cooperative communications and collaboration with all levels of Avanos employees, customers, contractors, and vendors.

    Performs other related duties and responsibilities as requested


    Reporting Relationships:
    Direct report the Vice President of Strategy and Marketing

    Positions reporting to this job include:

    1 Reimbursement Operations Manager

    2 Reimbursement Patient Access Specialist

    1 Field Director of Payor Engagement


    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


    Job Requirements:

    Education:
    Bachelor's degree required. MBA desirable.

    Experience:10+ years of medical device reimbursement, third party billing experience, strategic marketing experience.

    Successful performance in this position requires a broad-based knowledge in medical device market access., reimbursement, patient access, payer coverage policy, employee management, business management, project management, marketing, and extensive experience in general health care.

    Strong communication, interpersonal, and analytical skills. The candidate must have excellent leadership qualities.

    Soft Skills:
    Persuasive, self-driven and motivated. Strong analytical and presentation skills, innovative and resourceful. Ability to communicate effectively, both written and orally.

    Preferred Skills:
    Demonstrated clinical acumen through interface with various physicians. Ability to drive appropriate payment coverage of IVP products by payers. Medical device industry experience required.

    Computer 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., ), or aptitude to learn such tools. General ability to learn and acclimate to new systems.

    Location:

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


    Avanos Medical 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.

    If you are a current employee of Avanos, please

    .

    Join us at Avanos

    Join us and you can make a difference in our products, solutions and our culture. Most of all, you can make a difference in the lives, people, and communities around the world.

    Make your career count


    Our commitment to improving the health and wellbeing of others begins with our employees - through a comprehensive and competitive range of benefits.

    We provide more than just a salary - our Total Rewards package encompasses everything you receive as an employee; your pay, health care benefits, retirement plans and work/life benefits.


    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.

    benefits on day 1

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