New job Regional Payer Manager - NE region in Connecticut | 2021

Position Summary

This Regional Payer Manager will work closely with the Payer Relations Director to develop and implement payer strategies to ensure optimized health insurance coverage and reimbursement for company products; they will also provide clinical expertise to inquiries and payer interactions associated with Tactile Medical product use. This position will provide guidance to Payers, Reimbursement Department, Sales Force, and Clinicians to improve payer communications, including global communications. They will research and develop payer climate synopsis and assess the current landscape of clinical information needs across departments and contribute to the development of prioritization as directed by management.

Accountabilities & Responsibilities

• Remove obstacles with respect to Coding, Coverage and Reimbursement that prevent patient access to Tactile products
• Identify and implement opportunities to collaborate with Payers
• Work with various specialty societies, associations and third-party consultants to find opportunities to educate the payer community about the value of Tactile products. Clearly deliver the products value message, understand the current reimbursement methodology and recommend changes needed to obtain unrestricted access for patients
• Attend various conferences
• Work closely with internal partners on pull-through opportunities with Payer customers on messaging and resources required to maximize patient access
• Be the internal "go-to" resource for reimbursement questions from the field
• Develop and foster a strong and effective relationship with health insurance carriers including commercial health plans, Medicaid programs and Medicare Advantage plans. Engage key payer personnel to allow Tactile Medical the ability to demonstrate the cost and medical benefits of our products for use with Lymphedema and wound care as well as any future uses that prove to be beneficial to the patient
• Analyze targeted payer data and develop and execute a strategic plan to overcome adverse payer criteria. Educate payer clinical review staff and/or medical directors about lymphedema and the treatment provided by our products
• Seek out and understand medical literature and research studies pertinent to diagnoses treated by company products and demonstrate ability to utilize that knowledge to influence payer perspective
• Participate in cross-functional projects to ensure proactive commercial aptitude while partnering with stakeholders to identify opportunities for efficiency and improved coverage/reimbursement. Collaborate and facilitate necessary training. Report the progress of projects to stakeholders. Coordinate implementation of quality control activities as necessary
• Communicate with Contracting Department regarding potential contracting opportunities. Collaborate with contracting team to develop and implement various advocacy tactics to obtain in network status
• Provide on-going communication to patients, field sales, clinicians, payers, peers, clinical research professionals and management. Direct questions and inquiries in a manner that allows all necessary information to be gathered with minimal inconvenience to all
• Provide insight in meetings and suggestions for continuous improvements and best practices, process improvement and product development
• Maintain compliance with all appropriate regulatory requirements including HIPAA

Education & Experience

Required:

• Bachelor’s degree in Health Policy, Finance, Business or other related field or equivalent experience

• 7 years’ experience in health care reimbursement within the medical device industry or related field, including both commercial and Medicare payers
• Minimum of 5 years of relevant experience particularly managing national and regional payer and/or employer corporate relationships

Preferred:

• Clinical background

Knowledge & Skills

• Current and relevant working relationships with executive level decision makers at payers, Associations and Coalitions
• An entrepreneurial mindset
• Demonstrated understanding of CMS, Commercial payment models and trends
• An in-depth understanding of the payer's process & medical policy that has resulted in successfully improving market access.
• Strong understanding of Medicare and commercial payer methodologies (coding, coverage, clinical criteria, medical terminology, medical policies, denial tracking/resolution and payments)
• Skilled in persuasive writing, case review to assess coverage criteria, medical terminology, critical thinking and problem solving
• Self-starter with ability to work independently
• Excellent written communications skills with emphasis on persuasion and clinical knowledge
• Strong strategic thinking ability with bias towards action/execution
• Able to communicate comfortably and effectively both verbally and in writing with high level professionals including medical directors, government policy makers and the judicial system
• Ability to immediately gain confidence and respect of colleagues through demonstrated expertise
• Ability to proactively identify issues, problem solve and attain resolution
• Ability to influence others by applying appropriate medical/clinical research knowledge and experience to perceived obstacles
• Capable of aligning understanding of insurance companies with Tactile’s organizational goals and objectives
• Experience influencing commercial payer medical or coverage policies

Competencies

• Change Agent
• Influential
• Strategic Agility
• Planning
• Communication
• Priority Setting
• Relationships
• Problem Solving

It is the policy of Tactile Medical to provide equal opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, Tactile Medical will provide reasonable accommodations for qualified individuals with disabilities.