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Purpose of Job: The Southeast Market Reimbursement Manager will report to the VP of Reimbursement & Corporate Compliance. This high profile position provides local and regional payer and provider education and support in the Southeast to reduce and eliminate coverage and payment obstacles related to the company’s Renessa procedure. This position will be responsible for maximizing reimbursement from key payers in the Southeast by working closely with both physician offices as well as payers Initially the focus will be Florida and later may expand to other areas in the Southeast. The position involves up to 75% travel (mainly within Florida) for payer initiatives, customer support, sales support, and educational opportunities.

Major Duties and Responsibilities:
1. Work with physician offices to identify patients who will take their advocacy to the payers.
2. Work closely with each physician office in the Florida area on the pre-auth process to increase the chances for successful reimbursement.
3. Build coalitions and present group requests to payers for coverage decisions.
4. Negotiate with payers to obtain decisions.
5. Communicate daily with insurance companies, physician offices, patients, etc.; conduct provider and/or patient follow-up; develop and maintain professional relationships with all contacts.
6. Manage local and regional payer relations activities as assigned by the VP.
7. Responsible for organizing internal & external resources to optimize payer policy coverage from private and government health insurers in the Southeast.
8. Proactively identify and cultivate opportunities for obtaining payer agreements or coverage decisions; coordinating and facilitating physician champions and Company presentations to effect positive coverage agreements or policies.
9. Troubleshoot payment obstacles of government programs, managed care, integrated delivery, private pay, and various other payer models.
10. Present the Renessa® technology to key payers, employer groups, & TEC Assessment organizations.
11. Identify and develop specific payer strategies for the Southeast including economic, clinical and advocacy information with input from VP Reimbursement, VP Sales and Chief Medical Officer.
12. Develop strategies with the Sales Manager in the Southeast to ensure a favorable reimbursement environment for customers.
13. Coordinate with the Sales Manager in the Southeast on many fronts including, but not limited to, payer and physician practice education, the identification of coverage/payment opportunities and as a general first line “expert” on reimbursement and coverage issues.
14. Identify opportunities to market, communicate, and educate regarding the Renessa procedure.

Educational and Experience Requirements: College degree with a minimum of eight years experience in reimbursement and payer/provider relations with a medical device company. Must know Southeast payers intimately and have specific experience obtaining coverage decisions from them (ideally for Category III CPT codes). Must have contacts within Provider Relations and Medical Director/Clinical Coverage staff. Must have experience negotiating carveout payment rates for new technology and/or Category III CPT codes. Must be as “provider” relations oriented as they are “payer” relations oriented. Must have experience working with the Urologists/Urogynecologist provider market.

Other Qualifications
1. High level of interpersonal skills: influencing, resolving conflict, and creative problem solving.
2. Must be an excellent communicator using all available channels.
3. Requires strong professional written and verbal skills with ability to communicate complex concepts.
4. A mature self starter who has the ability to work independently.
5. Previous leadership & management responsibilities.
6. Understanding of pre and post-launch medical devices.
7. Knowledge & understanding of clinical studies with ability to analyze new published data/literature of in-house and competing technologies.
8. Ability to make effective presentations to all levels of management, physician, professional society, and medical policy staff.
9. Strong organizational skills, ability to prioritize and complete projects.
10. Strong understanding of Medicare billing/coding and has extensive experience with ICD 9, CPT, HCPCS, RVU, DRG, APC.
11. Understanding and compliance with HIPPA regulations.
12. Can access, navigate, and interpret CMS website data i.e. Federal Register, Medicare policies, physician fee schedules, etc.
13. Strong knowledge of government and private payer reimbursement models.
14. Proven relationship building/cultivating capabilities.
15. Ability to think strategically.
16. Strong sales and account/customer management ability.
17. Goal and team oriented.
18. Strong computer literacy with Word, Excel database creation & maintenance, PowerPoint, Adobe, etc.
19. Tracking trends and developing reporting tools & databases.
20. Ability to handle ever changing fast-paced environment.
21. Innate talent for multi tasking and personal initiative.

• Location: Florida
• Telecommuting is ok.
• Principals only. Recruiters, please don't contact this job poster.
• Please, no phone calls about this job!
• Please do not contact job poster about other services, products or commercial interests.