Health Policy Manager, Surgical and Wound Care

3 weeks ago

Marietta, United States MiMedx Full time

Function as internal Subject Matter Expert for surgical, inpatient, and operating room reimbursement. Develop internal and external reimbursement and economic training, tools, and messaging. Seek coverage opportunities with payors as appropriate. Monitor and shape government and commercial payor trends. As needed, support outpatient core wound care business from a policy perspective.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Develop appropriate and compliant surgical and inpatient reimbursement training resources for sales and other internal partners, and function as an ongoing resource.
  • Develop appropriate and compliant surgical and inpatient reimbursement educational pieces for external clients.
  • Work with cross-functional teams (such as Informatics, National Accounts, Sales Operations, and Clinical) to identify opportunities and refine health economic messaging.
  • Evaluate diagnoses, product, and procedure codes for potential use with MIMEDX products.
  • Further the understanding of reimbursement in relation to commercial contracts.
  • Establish and maintain relationships with key payors and providers; provide input in planning and development of customized policy presentations and supportive materials for the payor/audience.
  • Review health plan medical policy drafts for submission of coverage requests to commercial and government payors.
  • Provide interpretation and clarification on product coverage questions in relation to payor coverage; communicate responses to surgical sales teams.
  • As needed, support outpatient core wound care business from a policy perspective.
PROBLEM SOLVING:
  • Performs full range of standard professional level work that typically requires processing and interpreting, more complex, less clearly defined issues. Identifies problems and possible solutions and takes appropriate action to resolve.
  • Demonstrates skill in data analysis techniques by resolving missing/incomplete information, inconsistencies/anomalies in more complex research/data.
DECISION MAKING/SCOPE OF AUTHORITY:
  • Nature of work requires increasing independence; receives guidance only on unusual complex problems or issues.
  • Work review typically involves periodic review of output by supervisor and/or direct "customers" of the process.
SPAN OF CONTROL/COMPLEXITY:
  • Fully competent and productive professional contributor, working independently on larger, moderately complex projects/assignments that have direct impact on department results.
EDUCATION/EXPERIENCE:
  • BS/BA in related discipline
  • 3+ years' experience working with surgical and inpatient reimbursement, both outpatient and inpatient, as well as Ambulatory Surgical Centers. Understanding of commercial insurance dynamics.
  • Strong working knowledge of acute care inpatient DRGs, ICD-10 PCS and outpatient CPTs.
  • AAPC or AHIMA coding certifications preferred.
  • Experience reviewing annual CMS proposed and final rules a plus, with emphasis on inpatient rulings.
  • Demonstrated knowledge of government/non-government medical policies and payor procedures.
  • Understanding of key positions and workflow within inpatient and operating room, with the ability to dialogue meaningfully with clients.
  • Understanding of reimbursement in relation to commercial contracts.
SKILLS/COMPETENCIES:
  • Excellent oral, written, and interpersonal communication skills
  • Ability to interact with all levels of management, both internal and external, third party payors, and customers
  • Proficient in Microsoft Office (Excel, Word, etc.)
  • Organized, flexible, and able to multi-task while maintaining a high level of efficiency and attention to detail
  • Strong analytical skills, clinical interests, and problem solving skills
  • Ability to influence others to achieve desired results using tenacity and diplomacy
  • Strong research and presentation skills


WORK ENVIRONMENT:

The work is typically performed in a remote office environment. Will be required to travel about 10% of the time.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)

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