Director, Market Access & Reimbursement - Alpharetta, GA or Remote

About the role

Customer facing role responsible for assisting in the execution of health economic and reimbursement strategies of Avanos’ interventional pain management products. Key functions to include coding and payment analysis, insurance authorization, coverage and cost effectiveness analysis as well as collaborating/building relationships with internal and external customers.

Responsibilities

• Creates strategies to obtain/optimize payment and coverage from third-party payers, CMS/other government payers, and healthcare customers for Avanos Medical’s product portfolio including MIC-KEY, ON-Q, AMBIT and Interventional pain (IVP) management products [TRIDENT and COOLIEF® cooled radiofrequency technology].
• Manages the national Market Access, Reimbursement, and Health Policy teams.
• Leads efforts to directly market payment/reimbursement opportunities and market access value propositions with payers, providers and value analysis committees to drive sales growth.
• Develop critical relationships with physicians and payers to drive appropriate clinical utilization on medically necessary patients and, therefore, sales of IVP product/s.
• Manages the national Market Access Reimbursement and Health Policy teams.
• Recruits, develops, leads the performance of employee(s) to develop the program aligned with market access , reimbursement and health policy.
• Leads the market access /reimbursement and health policy teams in developing and regularly updating reimbursement and health policy tools for use with sales, physicians, facilities and payers.
• Sets goals which align to Avanos’ organizational plans and manages the execution of goals through mentoring.
• Develop the Avanos national payer strategy to market the value proposition of products directly to payers to secure favorable product reimbursement.
• Leads efforts to directly market payment/reimbursement opportunities and healthcare economic value propositions with payers, providers and value analysis committees to drive sales growth.
• Provide strategic expertise to sales and marketing to develop and implement plans to achieve sales/revenue objectives.
• Develop critical relationships with physicians and payers to adopt clinical utilization of IVP (TRIDENT & COOLIEF), AMBIT, ON-Q and MIC-KEY products.
• Builds and formulates collaborative relationships with Avanos functional departments and serve as a liaison to external stakeholders.
• Drive facility and provider network development by providing market access, reimbursement and medical policy expertise to executive teams of health care systems, hospitals, independent, joint-venture and ASC management companies.
• Mentor professional education and sales teams to properly educate customers on the benefits of Avanos products on appropriate medically necessary patients.
• Influence appropriate government agencies and health care payers to obtain appropriate coverage and payment.
• Interact with the American Medical Association and CMS to obtain coding and coverage for new modalities/procedures and product codes.
• Manage and direct the monitoring of third-party resources and data that may be utilized to drive the creation of analyses.
• Monitor, interpret, and summarize changes in the external environment (regulatory/reimbursement changes, managed care arrangements, etc.) produces internal communication strategies on threats and opportunities with suggested action plans to IVP products.
• Is the internal and external subject matter expert on market access, reimbursement and medical policy matters related to Interventional Pain products.
• Complies with U.S. Food and Drug Administration (FDA) regulations, other regulatory requirements, company policies, operating procedures, processes, and task assignments.
• Maintains positive and cooperative communications and collaboration with all levels of Avanos employees, customers, contractors, and vendors.
• Performs other related duties and responsibilities as requested.

Qualifications

• Bachelor’s degree required, MBA desirable.
• 10+ years of medical device reimbursement, third party billing experience, strategic marketing experience.
• Medical device industry experience required.
• Successful performance in this position requires a broad-based knowledge in medical device market access, reimbursement, patient access, payer coverage policy, employee management, business management, project management, marketing, and extensive experience in general health care.
• Strong communication, interpersonal, and analytical skills.
• Excellent leadership qualities.
• Persuasive, self-driven and motivated.
• Strong analytical and presentation skills, innovative and resourceful.
• Ability to communicate effectively, both written and orally.
• Proficient in use of Microsoft PowerPoint, Excel, Windows and Microsoft Office.
• Experience with data visualization software (e.g., Tableau) and CRM applications (e.g., Salesforce.com), or aptitude to learn such tools.
• General ability to learn and acclimate to new systems.

Skills

• Strategic marketing experience.
• Market access, reimbursement, and health policy expertise.
• Collaborative relationship building.
• Leadership and mentorship.
• Communication and interpersonal skills.
• Data analysis and interpretation.
• Regulatory compliance.
• Project management.
• Healthcare industry knowledge.

Benefits

• 401(k) employer match of 100% of each pretax dollar you contribute on the first 4% and 50% of the next 2% of pay contributed with immediate vesting.
• Un capped sales commissions.