Area Reimbursement Manager

March 19

🤠 Texas – Remote

Although this job is listed in Texas, this company may be open to hiring remote in other states.

💵 $125k - $135k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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SI-BONE

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SI-BONE is a medical technology company that specializes in the diagnosis and treatment of sacroiliac (SI) joint disorders, a significant cause of chronic low back pain. The company is best known for its iFuse Implant System, a minimally invasive surgical device designed to stabilize and fuse the SI joint. SI-BONE provides a range of resources for patients, healthcare providers, and investors, including educational materials, clinical evidence, patient stories, and webinars. Their solutions aim to reduce pain and enhance mobility in patients suffering from SI joint dysfunction.

Orthopaedic Spine • Neurosurgery

201 - 500 employees

⚕️ Healthcare Insurance

📋 Description

• Reports to Area Reimbursement Director • Acts 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 • The Area Reimbursement Manager must 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. The company does not tolerate retaliation in connection with making good faith reports of suspected violations. • Responsible for performing 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 • Delivers 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

🎯 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; • Direct experience with Medicare Transitional Pass-Through (TPT) and New Technology Add-On Payment (NTAP) preferred • Previous coding and billing experience in an office, hospital, ASC setting preferred • Experience in Medical Device Industry preferred

🏖️ Benefits

• Supplemental pay: bonus and stock