Health Economics Manager
2 weeks ago
**Why join Stryker?**
**Who We Want**
**Collaborative partners.** People who build and leverage cross-functional relationships to bring together ideas, information, use cases, and industry analyses to develop best practices.
**Effective communicators**. People who can interpret information clearly and accurately to concisely communicate results and recommendations to stakeholders, senior management, and their teams.
***Analytical problem solvers.** People who go beyond just fixing to identify root causes, evaluate optimal solutions, and recommend comprehensive upgrades to prevent future issues.
**What You Will Do**
Reporting into the Senior Director of Health Economics Outcomes Research (HEOR), Reimbursement & Market Access, provide cross-functional or cross-divisional technical expertise on health economics, reimbursement & market access for Stryker’s products, manage projects from beginning to end and assist with the development and training of sales/marketing support tools related to the reimbursement and economic value messaging for Stryker’s products
- Develop and oversee the creation of value-based resources (e.g., value summaries, calculators, etc) and clinical-economic evidence (i.e, abstracts, posters, and manuscripts)
- Manage projects with outside vendors (Optum, Premier, etc) to gather and review evidence development builds (retrospective claims analysis, health economic models, etc.) to support market access strategies
- Anticipate change, analyze potential access and reimbursement issues and opportunities in the healthcare landscape impacting Stryker products
- Provide analysis with no supervision to support cross functional, cross divisional (i.e. Sports Medicine) and OUS teams in development of health economic, value messaging, reimbursement and coverage strategies based on strong understanding of physicians, business/practice managers, payors, and their decision-making systems
- Ensure timely and quality deliverables (i.e. Government responses, sales and education tools) that support development of strong value propositions for Stryker Products
- Lead and confidently deliver internal and external coding, coverage, reimbursement/market access strategies, education, tools and support
- Implement and develop communication projects to keep Stryker regularly informed about coding/coverage/reimbursement issues affecting the company and its customers
- Assist with the execution of health economic and reimbursement strategies to ensure appropriate reimbursement of Stryker products from both government and private payor health care organizations
- Lead, advise and communicate the reimbursement and economic value messaging with confidence for Stryker products by providing health economic and reimbursement support for internal (i.e. Sales, Marketing, etc.) and external customers (i.e. physicians, billing staff, etc.).
- Develop and present training material and tools, gathering data for health economic studies, collecting and distributing reimbursement information that describes coverage, coding, and payment.
- Provide input and expertise to internal cross divisional teams as it relates to the health economics, reimbursement, billing and coverage of Stryker Products
- Assist with managing the operations of planning and communication with cross functional teams
- Prepare template letters of medical necessity, KOL product support letters and coverage introduction materials.
- Lead coding and coverage research using available resources including payor websites, coding resources and manuals, AMA, CMS, customer experience and external experts.
- Excellent knowledge of CPT, ICD-9, ICD-10, APC, HCPCS and revenue coding; inpatient/outpatient ASC and physician reimbursement across government and private payor environments.
**What You Need**
- Bachelor’s degree required with a preferred discipline (health economics, outcomes research, epidemiology, pharmacology, public health, health services)
- 8+ years in health economics, epidemiology, health services, or related field required
- 3+ years experience in reimbursement, medical billing and claims analysis experience preferred.
- Experience writing abstracts and manuscripts and creating posters and presentations for key opinion leaders to present at conferences preferred
- Excellent knowledge of the reimbursement pathway medical procedure billing and documentation requirements.
- Possess a strong understanding of Commercial payors, Medicare and state Medicaid plans
- Understanding of all data required on a Health Care Financing Administration (HCFA) 1500billing form.
- Knowledge of National Coverage Decisions (NCD), Local Coverage Decisions (LCD), Non-Coverage Decisions, billing codes and modifiers assigned by the Centers for Medicare and Medicaid Services (CMS).
- Knowledge of Commercial payor Medical Coverage and Reimbursement Policies and Guidelines.
- Knowledge of state Medicaid Fee Schedules and Medical Coverage and Reimbursement Policies and G
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