Head of Healthcare Economics & Reimbursement

Job Description

The Head of Healthcare Economics & Reimbursement will develop and execute comprehensive reimbursement and market access strategies to secure favorable coverage, coding, and payment for EBR Systems' products. This role will focus on code development, payer management, supporting customers with reimbursement education, and solving coverage-related issues while partnering with cross-functional teams. The individual will ensure that EBR Systems' solutions meet payer requirements and offer value-based economic benefits to providers and patients.

Products

• WiSE CRT System

Minimum Requirements

• Experience: 10+ years in reimbursement, healthcare economics, or market access, particularly within the medical device industry. Experience with payer negotiations and managing reimbursement programs is essential.
• Education: Advanced degree in healthcare economics, public health, or a related field.
• Reimbursement Expertise: In-depth knowledge of healthcare reimbursement systems, including CMS, private payers, and government policy.
• Customer Focus: Strong ability to assist customers with coding, coverage, and payment queries while providing ongoing support for practice economics and optimal product reimbursement.
• Analytical Skills: Proficiency in developing healthcare economic models, conducting HEOR research, and supporting payer submissions.
• Team Leadership: Proven track record in managing cross-functional teams and collaborating with external stakeholders, including payers, providers, and regulatory bodies.

Job Requirements

• Reimbursement: Collaborate with market experts and stakeholders to develop and execute a comprehensive reimbursement strategy for securing sustainable coverage from government and commercial payors.
• Build and maintain relationships with payors, advocating for the value of the company's medical devices and ensuring alignment with evolving policies and criteria.
• Lead efforts to develop and secure new reimbursement codes for novel medical devices by collaborating with regulatory bodies, industry associations, and healthcare providers. This includes gathering clinical and economic evidence to support the application, submitting proposals to the appropriate authorities (e.g., CMS for CPT or HCPCS codes), and ensuring alignment with industry standards to facilitate coding, billing, and coverage for the device.
• Payer Strategy Development: Design and implement focused payer and managed care strategies across local, regional, and national healthcare systems. Build and maintain relationships with key payers.
• Reimbursement Support: Provide reimbursement programs, informational support, and educational materials to customers, assisting them with payer requirements, coverage, and coding issues.
• Market Access & Evidence Generation: Lead health economics and outcomes research (HEOR) initiatives to demonstrate product efficacy, cost-effectiveness, and clinical value to drive market access and payer acceptance.
• Customer & Sales Support: Educate providers, physicians, and facilities on reimbursement processes, coding, and documentation of medical necessity.
• Address customer inquiries and support field sales through training on product economics.
• Issue Resolution: Act as the go-to expert for solving reimbursement and coverage challenges, responding to customer inquiries, and offering actionable information to support their coding and billing needs.
• Trend Analysis: Track payer and provider trends by geography to identify opportunities and address reimbursement challenges across markets.

Compensation Information

• Depending on experience level - flexible
• Equity involved

Location

• Territory Parameters: Nationwide - REMOTE
• Acceptable Candidate Location: US Based