Senior Director, Reimbursement & Health Economics

Main Responsibilities

• Strategic Reimbursement Leadership
• Develop and execute comprehensive reimbursement and market access strategies supporting the Company’s current and future spinal implant portfolio.
• Serve as the internal expert on coding, coverage, payment, and health economics, providing strategic guidance to executive leadership and cross-functional teams.
• Integrate reimbursement strategy into product development, clinical evidence generation, regulatory planning, and commercialization activities.
• Monitor changes in reimbursement policies, healthcare regulations, and payment systems to identify opportunities and mitigate business risk.
• Coding Strategy
• Lead development and execution of coding strategies supporting new and existing technologies.
• Collaborate with physician leaders and specialty societies to advance CPT coding initiatives through the American Medical Association (AMA) CPT Editorial Panel process.
• Develop and maintain strategies related to CPT, HCPCS, ICD-10-PCS, and other applicable coding systems.
• Work closely with internal and external stakeholders to ensure appropriate coding pathways support adoption of the Company’s technologies.
• Coverage & Payment Strategy
• Develop and execute Medicare and commercial payer coverage strategies to improve patient access.
• Lead engagement with CMS, Medicare Administrative Contractors (MACs), commercial payers, and other reimbursement stakeholders.
• Develop strategies supporting favorable physician, hospital, ambulatory surgery center, and outpatient payment.
• Identify reimbursement barriers and implement solutions that facilitate customer adoption and long-term commercial success.
• Health Economics & Evidence Development
• Develop health economic and outcomes research (HEOR) strategies demonstrating the clinical and economic value of the Company’s technologies.
• Partner with Clinical Affairs to identify evidence needs supporting reimbursement, coverage, and market adoption.
• Guide development of economic models, budget impact analyses, value dossiers, reimbursement tools, and supporting evidence.
• Commercial & Cross-Functional Support
• Partner closely with Commercial Leadership, Marketing, Clinical Affairs, Regulatory Affairs, and Product Management, to support product launches and commercialization initiatives.
• Develop reimbursement education materials and provide training for the commercial organization.
• Support strategic customer meetings by serving as the Company’s reimbursement expert.
• Manage external reimbursement consultants and advisors to ensure successful execution of strategic initiatives.
• External Relationships
• Build and maintain productive relationships with physician key opinion leaders, specialty societies, payer organizations, professional associations, and reimbursement policy experts.
• Represent Providence Medical in interactions with the AMA, CMS, specialty societies, reimbursement organizations, and other external stakeholders.
• Participate in industry meetings and professional organizations to maintain awareness of reimbursement trends affecting the spinal implant market.

  Qualifications

  • Bachelor’s degree in Business, Healthcare Administration, Health Economics, Public Health, Life Sciences, or related discipline.
  • Minimum of 10 years of progressive experience in reimbursement, market access, health economics, or related functions within the medical device industry.
  • Demonstrated experience supporting commercialization of spinal implant technologies.
  • Proven success developing and executing coding, coverage, and payment strategies for innovative medical devices.
  • Experience working with the AMA CPT Editorial Panel process, physician specialty societies, and reimbursement policy organizations.
  • Strong understanding of Medicare, commercial payer reimbursement, physician payment systems, hospital reimbursement methodologies, and ambulatory payment systems.
  • Experience managing external consultants and leading complex cross-functional initiatives.
  • Excellent communication, presentation, negotiation, and relationship management skills.
  • Demonstrated ability to independently develop strategy while personally executing key initiatives in a highly collaborative environment.