Director, Reimbursement and Market Access

About the Job

The Director of Reimbursement and Market Access is responsible for assisting the Senior Vice President of Reimbursement and Market Access by collaborating with life sciences clients to provide analysis and insight related to coding, reimbursement, practice management, and policy. This individual will leverage internal data sources and professional experience to effectively support clients in developing and implementing reimbursement and market access strategies for their drugs, devices and other healthcare technologies.

Duties and Responsibilities

• Develop and implement coding and reimbursement strategies for new and existing drugs, biologics, medical devices, digital technologies and diagnostic tests
• Lead client project engagements by serving as the direct point of contact for clients and coordinating with project teams
• Evaluate drugs and technologies to assess the potential applicability of coding options (HCPCS, CPT, ICD-10-PCS, and ICD-10-CM)
• Submit applications to relevant organizations (e.g., CMS, AMA) to request, modify, or delete codes
• Maintain a deep understanding of commercial and government payer coverage policies, guidelines, and payment methodologies, and apply this knowledge to project engagements
• Translate data and insights into actionable strategies and tactics
• Assess how payer coverage and payment policies apply to drugs, biologics, and other medical technologies
• Develop and deliver educational programs and training presentations, platforms, and exercises related to coding and reimbursement
• Create educational resources (e.g., guides, brochures, tipsheets) that assist stakeholders with understanding coding, coverage and payment of specific drugs and healthcare technologies
• Support data analytics teams by identifying relevant codes for use in claims studies
• Serve as a subject matter expert in reimbursement and coding
• Carry out responsibilities in accordance with organizational policies and applicable laws

Requirements

Skills and Abilities

• Strong verbal and written communication skills
• Excellent analytical, problem-solving, and strategic thinking skills
• Strong understanding of healthcare coding and reimbursement
• Proficiency in Microsoft Office applications (Word, PowerPoint)
• Strong interpersonal skills
• Alignment with company values, demonstrated by a strong sense of commitment, accountability, and engagement with colleagues
• Consistent ability to work under pressure, multitask, prioritize, manage time effectively, and meet deadlines

Experience

• Bachelor’s degree from a four-year college or university
• Seven (7) or more years of related experience with healthcare consulting, practice management, revenue cycle management, payers, or life sciences industries
• Full coding certification (through AAPC or AHIMA) required
• Demonstrated ability to build and maintain internal and external relationships with stakeholders across multiple disciplines

Qualities

• Thrives in a rapid-paced environment
• A natural learner with a strong interest in understanding business operations and complexities
• Strong strategic and critical thinking capabilities
• Excellent organizational and time management skills
• High personal credibility with the ability to build trusted relationships with clients and internal stakeholders
• Comfortable functioning as both a team player and a leader