Area Reimbursement Manager

Summary

Join SI-BONE, a leading medical device company, as an Area Reimbursement Manager. You will act as the internal expert on coding and reimbursement for SI-BONE's product portfolio, collaborating with sales, physicians, and payors to secure coverage for iFuse implantations. Responsibilities include case management appeals, payor relations, and developing reimbursement materials. The ideal candidate possesses a Bachelor's degree, 5+ years of reimbursement experience in the medical device or pharma industry, and expertise in medical device reimbursement coding and coverage. The role requires strong communication, analytical, and problem-solving skills, along with proficiency in relevant software. SI-BONE offers a competitive salary, bonus, and stock options.

Requirements

• Bachelor’s degree or equivalent experience
• Minimum of 5 years of experience in reimbursement activities with a medical device or pharma company
• Significant experience in creating market access with commercial payors
• A strong understanding of medical device reimbursement coding, coverage and payment processes and practices
• Available to travel as needed
• Thorough knowledge of reimbursement
• High level of interpersonal skills: influencing, resolving conflict, and creative problem solving. Must be an excellent communicator using all available channels
• Ability to make effective presentations to cross functional areas of the company, and to outside healthcare professionals and payors
• A history of successfully managing relationships at all levels of the organization
• Strong organizational skills, ability to prioritize and complete projects
• Effective analytical and problem-solving skills with the ability to handle multiple projects and apply creative solutions to challenges
• Possess a high level of energy and collaborative management style
• Demonstrated proficiency with Word, Excel, PowerPoint and Salesforce.com
• Ability to work in a fast-paced, thinly resourced organization
• Knowledge and familiarity of applicable regulations/standards (e.g. ISO 13485, FDA 21 CFR 820, EU MDR 2017/745, ISO 14971) as required to perform the job function

Responsibilities

• Report to Area Reimbursement Director
• Act as the internal expert and resource on coding and reimbursement for SI-BONES product portfolio
• Provide effective collaboration between the reimbursement team, sales organization and physicians/surgeon’s offices to develop case reimbursement strategies in attempts to secure coverage for iFuse system implantation
• Build collaborative relationships with Territory and Regional sales representatives to prioritize and optimize reimbursement support services in the region
• Interface and collaborate with governmental reimbursement entities (Medicare, Medicaid, TRICARE, etc.) and commercial payors in assigned region
• Collaborate with marketing, clinical, regulatory, and sales teams concerning ongoing operation’s needs
• Act and conduct company business in an honest, ethical and lawful manner, consistent with the company’s Code of Conduct, other company policies and the AdvaMed Code of Conduct and/or any other applicable industry code(s) of conduct
• Perform all duties in compliance with all applicable worldwide regulatory requirements as included in the scope of the SI-BONE Quality Manual
• Execute case management appeal activities to ensure optimal opportunity for successful overturn of denied iFuse claims by providers to support education on medical necessity – either physician/surgeon and/or facility, i.e., inpatient, outpatient, office-based lab, and ambulatory surgery center
• Provide subject matter expertise regarding payors and coverage
• Execute payor relations activities to yield favorable coverage decisions
• Proactively seek out payor presentation opportunities
• Participate in development of reimbursement presentation and training materials relative to physician users and payor decision-makers with relevant internal stakeholders
• Execute coding strategy for all sites of care
• Visit surgeon’s offices in person or virtually to provide overview of Patient Insurance Case Support program and resource offerings
• Represent the company at medical conferences, physician, payor, tradeshows and company meetings as SI Bone’s reimbursement expert, as appropriate
• Collaborate and communicate regularly with reimbursement team and sales teams
• Deliver clear messages that are disseminated to SI-BONE leadership regarding payor trends, reimbursement changes, and billing & documentation requirements relating to SI-BONE products
• Support the SI-BONE Quality System
• Other duties as assigned

Preferred Qualifications

• Direct experience with Medicare Transitional Pass-Through (TPT) and New Technology Add-On Payment (NTAP)
• Previous coding and billing experience in an office, hospital, ASC setting
• Experience in Medical Device Industry
• Demonstrated success in handling a reimbursement region with another medical device company
• Experience in development of medical coverage policies and gaining favorable coverage decisions with government and commercial payors

Benefits

• Salary range: $125,000- $135,000
• Bonus
• Stock