The Reimbursement Manager (RM) serves as the market coverage and access expert to minimize reimbursement barriers for patients and providers and optimize access to products. The RM will work closely with internal/external teams, product/marketing manager, market development mangers (sales) and clinical account managers to support targeted accounts for medical benefit offered by both private and government payors.
The RM will be the coverage and policy subject matter expert. He/she will also develop ethical and customer-oriented reimbursement tactics, and proactively communicate payer criteria/terms and practices, as these relate to reimbursement. The RM will work closely with State level policy influencers to stay abreast of changes that can impact clients’ products.
Duties and Responsibilities
ü Provide subject matter expertise on all coverage issues.
ü Respond to reimbursement policy, payment and billing questions from sales, clinical, marketing and customers.
ü Educates clients on claims management, billing and coding policy, and assists with prior authorizations and denials.
ü Develop and implement up to date educational programs and materials for customers and internal business partners on health economics and reimbursement issues.
ü Surveillance of CMS and Medicare Administrative Contractor’s websites to ascertain policy updates and other information that impacts SCM and customer’s reimbursement strategy.
ü Conducts policy reviews and provide policy updates on private payers.
ü Communicate coverage and payment policy changes to customers.
ü Recommend/create tools that can enhance field sales interactions with hospitals, ASC’s and clinicians.
ü Work to build facility/clinician champions we can use with targeted payers.
ü Attends relevant key strategic marketplace meetings and presentations.
ü Develop and implement strategies to engage physician associations to influence coverage decisions.
ü All other duties, as assigned.