Field Reimbursement Manager - Central Region
In this role, you will support the Wound Reimbursement department to achieve its mission to connect patients, providers, and payors and ensure patients can access best-in-class technologies and products (Grafix, Oasis, and PICO). You will serve as the primary reimbursement expert supporting the field in all areas related to reimbursement of Company products and assist the Director or Sr. Director on execution of company strategies related to field reimbursement initiatives, including patient and HCP on-boarding and education, compliance, resources and communication. The FRM will need to work independently, develop strong relationships with each account, and develop strategies for prioritizing work and executing educational and supporting roles in a rapidly changing market. You will work to ensure Company products are properly reimbursed and patient reimbursement related issues are resolved in a timely manner, always exemplifying professionalism, a great attitude, conflict resolution tactics, and exceptional customer service skills.
- Serve as the primary contact for reimbursement support and educate new and existing customers on billing, coding, how to submit claim forms, national and local coverage policies, and good clinical documentation.
- Act as the key liaison between the Reimbursement Hotline, providers, and Sales for monitoring and addressing issues related to insurance verification requests (IVR) using cloud-based workflow solutions.
- Educate providers and staff on payer policies, coverage criteria, claims issues, denials, and appeals related to S+N products.
- Develop, utilize, and improve internal systems, processes, and tools for improving patient access in collaboration with Sales, Hotline, and Market Access colleagues.
- Monitor regional policy changes and work closely with the Market Access and the Hotline to ensure company has the latest coding information, coverage policies, claims outcomes, and treatment guidelines.
- Bachelor's Degree in the business, health sciences, management, healthcare administration or related field
- Advanced degree (MBA, MS, etc.) Preferred
Licenses/ Certifications: Certified Professional Coder is a plus
Location: Central - - MN, WI, IA, MO, KS, ND, SD, NE
- 8+ years of experience in biotechnology, pharmaceutical, medical device, or medical/hospital management industry
- 3+ years of experience in reimbursement, billing and coding within the healthcare, biotechnology, pharmaceutical, wound care or surgical device fields
- Comprehensive knowledge of healthcare reimbursement practices, billing procedures, compliance, coding, and medical terminology
- Strong background in sales, management, or reimbursement for "buy and bill" products in the biotechnology industry related to biologics, wound care and/or surgical procedures preferred
- Experience in wound care ICD-10 codes, coding, and billing preferred
- Broad knowledge of healthcare documentation, medical policy guidelines, compliance, billing, coding and reimbursement related to buy and bill biotechnology, wound care, device or DME.
- Strong problem solving and business acumen skills with an ability to work independently, manage priorities, develop strong relationships with customers.
- Ability to interact professionally at multiple levels within a patient- and customer-oriented organization and develop trusting relationships
- Excellent organizational, written and verbal communication skills
- Ability to work professionally and compliantly with highly confidential personal health information (PHI).
- Experience with Microsoft based applications, CRM, and ability to learn internal systems
- Employee is regularly required to stand, sit, talk, hear/listen, and use hands and fingers to operate a computer and telephone keyboard
- Close vision requirements due to computer work
- Must be able to drive a car
- Must be able to travel long distances by airplane, car, and/or train
Up to 65%
Smith+Nephew has a proud history of more than 160 years of improving health around the world. Whilst we have grown significantly from our beginnings as a small family pharmacy in Hull, England, our caring spirit has remained the same.
Care, Collaboration, & Courage:
Care means that we show empathy and understanding for each other, our customers and patients.
Collaboration means we work together as a team, based on mutual trust and respect.
Courage is about continuous learning, innovation and accountability.
At Smith+Nephew, we offer competitive and rewarding compensation and benefits packages!
Our benefits packages vary from country to country and by level, but often the total package includes the following:
- A competitive salary with an annual commission plan.
- Strong Healthcare coverage.
- A competitive company retirement benefit scheme for all employees.
We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation.
Smith+Nephew provides equal employment opportunities to applicants and employees without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability.
Veterans are strongly encouraged to apply.
Smith & Nephew is an Equal Opportunity/Affirmative Action Employer -EEO/AA/Minorities/Females/Disabled/Veterans and participates in the E-Verify Program.
As an equal opportunity/affirmative action employer, Smith & Nephew is committed to a diverse workforce. If you are a qualified individual in the US with a disability or a disabled veteran, you have the right to request a reasonable accommodation if you are unable or limited in your ability to use or access Smith & Nephew's career website as a result of your disability. You can request reasonable accommodations by calling Recruitment Support at 1-901-399-6192.