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.
Major Areas of Accountability
- Collaborates with the Director of Government Affairs, Reimbursement and Health Policy 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 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 Comfort Medical 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.
- Coloplast employees are required to conduct business to the highest ethical and professional standards; comply with applicable laws and regulations, the MedTech Code of Conduct, and company policies.
- Other job duties as assigned
Basic Qualifications
- 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
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
At Coloplast, we believe in recognizing and rewarding the contributions of our employees. Our total rewards package is designed to support your well-being, foster your professional growth, and ensure a healthy work-life balance. Here is some of what you can expect:
- Health and Wellness: Comprehensive medical, dental, and vision insurance plans to keep you and your family healthy. Plus, access to company sponsored wellness programs and mental health resources, paid leave of absence for qualifying events and generous paid parental leave for both birthing and non-birthing parents.
- Financial Security: A competitive 401(k) plan with company match that vest immediately, financial planning services to help you secure your future, and corporate discount programs for goods and services.
- Work-Life Balance: Generous paid time off, flexible work hours, and flexible work arrangement options to help you balance your personal and professional life may be available.
- Professional Development: Opportunities for continuous learning and career advancement through training programs, mentorship, and tuition reimbursement.
- Recognition and Rewards: Recognition programs to celebrate achievements and contributions, including peer recognition, bonuses, awards, and special events.
- Community and Culture: A supportive work environment where everyone feels valued, and has a sense of belonging. Participate in team-building activities, volunteer opportunities, and company-sponsored events. Sustainability strategy that outlines our ambitions for running our company in a more sustainable way.
- Competitive Compensation: The compensation range for this position is $129,000 - $190,000. Actual compensation is influenced by a variety of factors including but not limited to skills, experience, qualifications, and geographic location. Hired candidates may be eligible to receive additional compensation in the form of bonuses and/or incentives.
Pursuing an ambitious growth agenda, Coloplast develops and markets products and services that make life easier for people with intimate healthcare needs. Employing about 16,000 people and with products available in more than 143 countries, we are one of the world´s leading medical device companies. We are constantly growing our business and always looking for new ways to move forward – we explore, learn and look for new ways of doing things.
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Coloplast employees are required to conduct business to the highest ethical and professional standards; comply with applicable laws and regulations, theAdvamed Code of Ethics on Interactions with Healthcare Professionals, and company policies.
Coloplast is committed to a policy of Equal Employment Opportunity (EEO) which means we employ and promote individuals based on their merits, regardless of race, color, religion, sex, national origin, age, disability, veteran status, pregnancy, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status, status with regards to public assistance or any other protected classification.
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