Market Access and Reimbursement

Found in: Resume Library US A2 - 1 week ago

Woburn Massachusetts, United States Sirtex Full time
Job Description

The primary focus of this role is to provide field-based billing/ coding and reimbursement education and support to new and existing Sirtex accounts. This position collaborates with the Director, Reimbursement & Health Economics to provide strategic direction and development of country wide reimbursement programs to increase private, Medicaid and Medicare payer access.

 

This position will monitor and anticipate changing market conditions relative to public and private payer policies and their potential impact on the company business and will work to foster alliances with stakeholders, professional organizations and payer organizations to build continued support for payer coverage. The Market Access and Reimbursement Senior Manager; MARSM will manage country wide communications concerning issues impacting financial reimbursement for Sirtex products. The MARSM will assist in monitoring reimbursement compliance as it relates to industry standards for national, state, and local coding and billing guidelines.

The MARSM will be expected to primarily understand U.S. reimbursement policies in a variety of settings, including physician office, hospital outpatient, inpatient and ambulatory surgery centers. The MARSM will be required to interact with a diverse customer base, including payer thought leaders, physicians and their office staff, as well as Interventional, Nuclear Medicine and Radiation Oncology hospital managers. The MARSM will have the ability to interpret and translate billing, coding, coverage, and payment information and communicate these concepts at all levels of the organization to facilitate positive coverage and reimbursement for Sirtex products.

This is a highly accountable and prominent position in Sirtex which requires engagement, partnership, and interaction with colleagues at all levels throughout the Sirtex matrix organization. Of paramount importance to success in the role is close partnership working with cross-functional team colleagues. The candidate should be extremely proactive and highly willing to engage both internally and externally and lead regarding providing successful market access solutions and developing Sirtex’s profile amongst oncology stakeholders of all types. The role demands strong project management experience and confidence in shaping, recommending and implementing strategy and initiatives across Sirtex’s matrix teams.

The candidate is responsible for conducting their activities on behalf of the company consistent with a high standard of business ethics and in compliance with the laws and regulations that govern our activities. The obligation encompasses the following:Takes personal responsibility for and demonstrates a high level of understanding of and adherence to the applicable internal policies, including but not limited to our Code of Ethics.

Adheres to business conduct and other policies applicable to the role, and external laws and regulations governing activities.

Exhibits high business ethics standard in dealing with internal and external stakeholders, including dealing with others honestly and openly, showing accountability, being reliable and trustworthy and being loyal to the company.

Completes all required compliance and ethics related training within required timelines.

Encourages a high level of understanding of and adherence to compliance and ethics amongst colleagues and third parties.

Fully co-operates in any internal and external audits, investigations and inspections.

RESPONSIBILITIES:

Conduct onsite reimbursement meetings for new and existing Sirtex accounts on the current Facility and Professional coding and billing guidelines for the SIRT procedure. Frequency as needed. Track and report customer attendance.

Identify the unmet educational needs of keys accounts and work with approved Sirtex tools to provide relevant training and education on coding, billing and Medicare and Medicaid reimbursement.

Develop reimbursement strategies and tactics aligned with Sales leadership that remove coding, coverage and payment barriers for SIRT therapy

Create and present customized CFO value proposition to expand SIRT therapy or to increase utilization in existing treating centers

Critically evaluate current procedures and practices. Develop and implement improvements as needed

Strong communication and presentation skills and the ability to translate complex reimbursement information into easy to implement strategies and tactics

Ability to communicate with customers at diverse levels in the organization, from CFO to Billing Clerk

Demonstrate a high standard of work ethic and professionalism to peers and leadership team members at all times

Excellent time management, organizational, and prioritization skills and ability to balance multiple priorities

Ensure strong alignment between regional business plans and reimbursement and market access activities.

Maintain a deep knowledge and mapping of payer environment, stakeholders and processes for both current and future Sirtex product lifecycles.

Maintain knowledge around Sirtex competitor payer messaging and strategy.

Develop and maintain effective networks with payer stakeholders.

Listens, collects and communicates actionable insights in a systematic way from key (payer) stakeholders, decision makers, competitors, and market trends to shape the value proposition and access strategy

Seek input and alignment with key internal stakeholders at local, regional and if required global level.

Ensure strong alignment between Reimbursement & Market Access and R&D on current and future evidence generation.

Effectively champion the payer value agenda with internal stakeholders

DEVELOPING EXPERTISE:

Develop and maintain a high level of knowledge concerning the scientific data that underpins the clinical benefits of Sirtex products and comparator treatments.

Develop reference knowledge of related health economic and clinical literature; seek to understand changing customer requirements and the implications of these to support market access throughout the life cycle in key markets.

Maintain and deepen a sound understanding of relevant Reimbursement & Market Access criteria and the likely payer perception of the product value proposition for Sirtex products.

Building and maintaining effective stakeholder relationships (internal and external)

Develop and maintain close working relationships with the internal multidisciplinary regional colleagues.

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