Director, Field Reimbursement

1 month ago

Canton, United States Organogenesis, Inc. Full time

About Us

We are a leading regenerative medicine company in the advanced and acute wound care space and are always looking for exceptional talent. Join a company where you will have an opportunity to grow professionally and personally and give strength to others by Empowering Healing. Our advanced wound care products are specially developed for the successful treatment of chronic and acute wounds. Our comprehensive portfolio of skin substitutes and other regenerative medicine products empower our patients with life-changing solutions. Our strength is giving others strength.

Learn more about Careers at Organogenesis

What You Will Achieve:

The Director of Field Reimbursement will operate as the leader and subject-matter expert on coding, coverage, and payment issues related to the Organogenesis portfolio of products to the Field Reimbursement Team. The Director will have a comprehensive understanding of all aspects of reimbursement models (coding, coverage, and payment), including complete understanding of Medicare A, B, C and D benefit designs, Medi-gap, physician fee schedule and ability to locate applicable coverage policies Demonstrated advanced level billing competencies including CPT, ICD-10, HCPCS coding and EOB interpretation. Ability to negotiate and execute sophisticated/C-suite level site of care discussions related to various health care topics access and reimbursement and able to set and pull through account level access strategies. This position is remote and reports into the Vice President of Commercial Development.

How You Will Achieve It:

* Educate the Field Reimbursement Managers, HCPs, and their staff on matters related to coding, coverage, and payment to facilitate appropriate patient access to ORGO products.
* Responsible and accountable for the successful implementation nation-wide of the strategic and tactical reimbursement plan for Field Reimbursement Team.
* Provide direction on specific and actionable activities that can be fully executed and measured by the Field Based Reimbursement team.
* Assimilate and build customer facing tools for implementation by the Field Based Reimbursement team.
* Analyze reimbursement issues and act as the reimbursement resource for the field sales force personnel and commercial leadership.
* Lead and coordinate with all internal teams concerning individual patient cases and overall coordination with field reimbursement team, customers, and the field sales force.
* Collaborate cross functionally with Field Sales, Marketing, Payer/Policy, Senior Leadership, Sales Training, and Medical Affairs while abiding by all corporate and industry policy guidelines and procedures.
* Support key opinion leader development from a corporate perspective and provide targeted support to commercial sites of service to eliminate barriers to access.
* Coach and coordinate the training for analyzing provider claim forms for errors and provide recommended modifications.
* Teach how to analyze remittance advices for denied claims and guide the team through the appeal process for any denied claims.
* Act as mentor and escalation point for Benefit Verification/Benefit Assurance teams.
* Perform Business Reviews/Claims Analysis for providers.
* Reimbursement subject matter expert for the Field Reimbursement Team.
* Provide semi-annual/annual evaluations of the Field Reimbursement Team.
* Work with C-Suite personnel to educate on the benefits in the utilization of ORGO products to treat chronic and surgical wounds
* Recruit, hire, and train Field Reimbursement Managers.

Job Requirements

What You Need to Achieve It:

* Requires BS/BA degree
* 4+ years of medical billing/coding, medical/pharmaceuticals sales, hospital revenue cycle, or healthcare insurance/payer experience
* Demonstrate analytical, problem solving, critical thinking, and relationship-building skills.
* Excellent communication, organizational and leadership skills
* Ability to travel up to 60% of the time. Face-to-Face interaction with customers preferred.
* AAPC billing/coding certification preferred.
* Must demonstrate a commitment to building strong relationships with customers.
* Collaborates to build strategic vision and skills across the organization.
* Possesses strong consultative skills.
* Ability to manage multiple projects simultaneously.
* Proven problem-solving skills.
* Committed to working as a teammate.
* Proficient in MS Office.
* Exceptional written and verbal communication skills.
* Principled, honest, creative, enthusiastic, independent, curious, coachable, solution-minded.

What can we offer you?

* 401k -- generous employer match with immediate vesting and financial planning resources
* Comprehensive Medical, Dental and Vision coverage options effective on day one of employment
* Flexible Spending Account (medical expenses or dependent care expenses) or Health Savings Account
* Company paid insurances including Short Term, Long Term and Life insurances as well as voluntary options
* Paid maternity leave and parental leave for all new parents
* Adoption benefits
* Education Assistance Policy - $5,000 per year for all employees
* Wellness Program including free trainings on mental health, mindfulness, stress reduction, on-site flu shots and more
* Employee Assistance Program
* Generous paid time off including vacation, floating holidays, sick days, and company holidays
* Free parking including an electric charging station (Canton and La Jolla)
* Discounts at BJs Wholesale, Dell, Sullivan Tire, and Sprint

Physical Demands

* Prolonged periods of sitting at a desk and working on a computer.
* Must be able to lift 15 pounds at times.
* Must be able to travel 50% of the time to work with customers and the field

Environmental Conditions

* No environmental conditions.

We are an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to age, sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, genetic information or any other characteristic protected by law.

Physical Required

Job Type

Full-time

Location

Home Based Telecommute - US - US (Primary)

Education

Bachelor's Degree

Career Level

Director

Travel

50 - 60%

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