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Coloplast has an exciting opportunity for a Senior Reimbursement Manager to join our growing team!
The Senior Manager, Reimbursement position is responsible for securing new coding, positive medical coverage, and adequate payment within the US by engaging with government payors, and for monitoring and shaping health policy to support innovative products and market access solutions for targeted Chronic Care Coloplast products and services.
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| Major Areas of Accountability |
- Assist in the development and execution of US reimbursement strategies to fight commoditization of DMEPOS products by shaping national/local coverage decisions and payment methodologies, engaging various stakeholders to influence/petition payers with coding, coverage and payment consideration requests.
- Manage, communicate and execute US reimbursement strategies that ensure Coloplast Chronic Care Products have strong value propositions in the Durable Medical Equipment, Prosthetics, Orthotics & Supplies (DMEPOS) products categories
- Partner with Government and Public Affairs to develop campaigns and initiatives to engage stakeholders to petition government payers with coding, coverage and payment consideration requests
- Partner with global and US cross-functional teams throughout product life cycles (product charter/program management, clinical studies and commercialization) to define evidence needs, develop and execute US reimbursement strategies and tactics that ensure Coloplast offerings have strong value propositions
- Analyze and provide insight on health policy issues affecting Coloplast business: developing argumentation based on evidence and policy data analyses, and advocacy including comment letters designed to influence policy
- Interpret clinical and economic evidence and articulate value proposition of Coloplast product, service and digital services to payers and health technology agencies
- Develop and maintain a current knowledge of the government payors landscape within DMEPOS markets
- Partner with Downstream Market Access and Government Affairs & Patient Advocacy teams to develop and deploy access and reimbursement solutions that support Coloplast growth strategies
- Interpret health policy regulations and appropriately comment to minimize negative implications
- Deliver and create clear and concise communications and presentations using approaches that highlight the most pertinent information for internal and external stakeholders that spur stakeholder action.
- Engage with government payors, physician champions, and professional societies articulating Coloplast’s unique value propositions to secure appropriate coverage, coding and payment policies for Coloplast technologies.
- Establish, execute and communicate government payor focused value messaging regarding Coloplast products
- Monitor and communicate health policy changes to internal stakeholders
- Maintain expert knowledge of government payor landscapes, trends, coverage issues, and payment methodologies pertinent to the Coloplast product lines particularly within DMEPOS.
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| Basic Qualifications
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- Illustrates a proven ability to operate within a cross functional MA team to develop public policy comments in response to the CMS annual calendar of rulemaking for DMEPOS, IPPS, OPPS & PFS.
- The ability to work independently with key stakeholders within a mulit-national company is highly desirable.
- Demonstrates a strong understanding of the “stage gate review process” within the pre-commercialization product development process
- Demonstrates knowledge and experience working with reimbursement within the Medical Device industry, private (Health Plans/Employers) and/or public payors (Medicaid/Medicare) in policy, access and reimbursement issues required
- Minimum 10 years’ experience working in the Medical Device, DME, managed care plan, Medicare/Medicaid arena
- Demonstrated ability to work with organizational decision makers, including medical directors, hospital administrators, etc.
- Extensive knowledge of the various payment methodologies, CPT and HCPCS coding systems
- Knowledge of managed care and/or insurance industry
- Excellent written and verbal communication skills. Strong oral, written and presentation skills, experience building customer/payor facing power point presentations
- Experience in the development of payer advocacy campaigns and documents describing the product, the comparators, market characteristics, clinical and economic evidence to support reimbursement and health technology assessment submissions
- Proven ability to successfully execute strategies in a matrixed organization
- Relationship building skills with global and US cross-functional internal and external audiences including physician customers, DME suppliers and/or payers or state-based government
- Other duties as assigned.
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| Preferred Qualifications |
- Master’s level degree in health services research, epidemiology, public health, medical related field, or health economics
- Ability to interpret clinical and economic evidence and articulate value proposition of Coloplast product, service and digital services to payers and health technology agencies
- Experience presenting clinical and economic evidence and tools required
- Hands-on experience partnering with payers at part of a hospital, clinical, Home Health agency, medical device manufacturer, DME suppliers
- Successful track record with DPAC applications and negotiations around HCPCS code verifications
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