Healthcare Policy and Reimbursement Manager

  • Company: Adecco
  • Location: Marietta, Georgia
  • Posted: January 19, 2017
  • Reference ID: 932944643

Health Policy and Reimbursement Manager/Senior Manager - Virtual/Remote USA

Outstanding Career growth opportunity with expanding Healthcare and BioTech firm, headquartered in Georgia

Manager or Senior Manager with 6+ years of health policy and/or reimbursement experience with pharmaceutical, biotechnology and/or device market.
Basic knowledge of payer market, including Medicare, Medicaid, Durable Medical Regional Carriers, Managed Care Organizations, insurance companies, insurance case managers and providers in the health care industry.
Responsibilities include communication with commercial payers including managed care organizations, case managers, indemnity insurers, payer medical directors as well as providers.
Expertise in review and understanding of payer policies within the healthcare market payer segment. Ability to work well within a team-focused organization.

Act as a Liaison to create health policy and reimbursement awareness through discussions and communications:

Demonstrate a working knowledge of communication skills necessary for provider and payer discussions.
Work Collaboratively with Health Policy Department to facilitate the overall department goals and objectives
Establish relationships with key providers and payers including providing input in planning and development of customized policy presentations and supportive materials for the payer or audience when necessary.
Assist Health Policy team in securing and protecting coverage for company product portfolio.

Review status of payer organizations in the territory for specific coverage issues with goal to maintain and protect current coverage utilizing software and reporting.
Make consultative calls with Health Policy team, Reimbursement Field Managers, and sales personnel as requested or necessary to support and resolve product coverage issues.
Demonstrate territory planning and time management skills by effectively managing the defined geographical area of responsibility.
Communicate with payers including managed care organizations, case managers, indemnity insurers and personnel regarding coverage policies for company portfolio.
Participate and assist in development of educational tools for field sales specific to coverage.
Provide support to Reimbursement Field Managers and field sales as requested and necessary.
Ability to develop and implement tracking systems using for monitoring coverage decisions by payer type.
Function as a team player in the organization by being aware of the scope, responsibility, and authority of job functions and activities and the impact on quality of service to the customer as it pertains to quality standards within the company.

Minimum of 6 years of experience in coverage, coding and payment policy required.
Must possess the ability to review, analyze, and articulate health care policy as well as assist in the submission of written coverage requests to payers.

Bachelor's degree from a four-year college or university
Professional billing experience and/or certification preferred.

Please forward Word version resume to:

Share this Job