This position is not about paying claims, but negotiating with our vendors on reimbursement policies. The position will be responsible for the coordination and growth of our reimbursement initiatives. To be successful in this position, person must be able to handle both the tactical level (i.e. help RSM’s and providers with denials, billing education etc.) as well as understand and contact payers on a higher level of reimbursement discussions. The person we are looking for must be able to work independently, be proactive and creative and know his way in the reimbursement regulatory maze. You will work closely and in coordination with our sales organization, leadership team and Regional Sales Managers, as well as other field professionals. It reports into the VP Strategic Planning & Health Economics.
Primary Responsibilities and Duties:
- Must be able to negotiate with Vendors to champion our CSM coding to ensure we get proper reimbursement.
- Understand and follow reimbursement guidelines and policies to include timely updates and communicate changes that affect reimbursement to management.
- Must be able to read policies, understand our device and technology and how our device is reimbursed.
- Must be able to contact payors (insurance companies) to increase reimbursement amounts.
- Keep track of payers’ policies and if they accept our products.
- Monitor and analyze payer’s policies and provide published data to company relevant staff. Provide data in order to address reimbursement challenges, such as usage volumes, number of covered lives etc..
- Contact and negotiate with insurance company to handle denials as well as policy issues.
- Point of contact for field agents (RSMs) and others when they need to understand coverage issues, or once they encounter a reimbursement problem.
- Lead the reimbursement efforts on the Tactical level.
- Address denials (why and how to solve).
- Educate providers (what to do to be reimbursed).
- Provide timely and effective solutions aligned with company needs
- Other job duties as assigned by management.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.
- Proven experience dealing with insurance companies and payors.
- Experience in Cardiovascular or Sleep Apnea required
- Experience with reimbursement of medical devices – preferred.
- Experience in working with specific tools monitoring payers’ policies such as Canary Insights or others.
- Proven negotiating and customer relationship management skills with the ability to navigate a complex process.
- Ability to effectively manage assigned accounts in terms of problem resolution and business planning.
- Proven effective verbal, computer, written and presentation/communication skills.
- Ability to quickly adapt and respond to job, environmental, and industry changes.
- Strong customer service skills, with excellent written & verbal communication skills.
- Strong analytical skills.
- Must be able to communicate effectively & maintain professional conduct at all times.
- Organized, self-starter with the ability to handle numerous projects and prioritize workload with minimal supervision.
- Travel up to 10%.
- BS Degree in health-related or similar field preferred
- 5+ years of reimbursement or comparable experience
- Experience and knowledge of sleep regulations helpful, (AASM, CMS, Etc.)
- Professional Coding Certification Required
This position has no direct supervisory responsibilities.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
- Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- The employee is required to sit – perhaps at long intervals of time
- The employee is required to work on computer for long intervals
- The employee is required to talk on the phone for long intervals
About Itamar Medical:
Itamar Medical Ltd is a medical technology company focused on the development, marketing and sales of diagnostic products based on its proprietary PAT platform technology, developed by a team of leading clinicians in sleep medicine and cardiology together with biomedical engineers and physicists.
WatchPAT is an FDA- cleared portable diagnostic device that uniquely uses finger-based physiology and innovative technology to enable simple and accurate Obstructive Sleep Apnea (OSA) testing while avoiding the complexity and discomfort associated with traditional air-flow based systems.
You have a unique opportunity to work with a world leader in the cardiology/electrophysiology medical field.
To apply, click here or contact:
USA Director of HR