Director, Patient Access & Healthcare Economics
Carlsmed
About Carlsmed
Our mission is to improve outcomes and decrease the cost of healthcare for spine surgery and beyond. The Carlsmed aprevo® personalized surgery platform is designed to improve the standard of care for spine surgery one patient at a time.
Position Description
The Director, Patient Access and Healthcare Economics will lead the Company efforts in the development and execution of strategies to ensure patient access to the aprevo® technology. This person will be the resident expert on Medicare reimbursement and Commercial plans for both inpatient and outpatient services, delivering crucial insights to understand the risks and opportunities in this continuously changing environment. The Director, Patient Access and Healthcare Economics will identify value propositions that resonate with both providers and payers and will collaborate cross functionally to develop market access support materials.
Responsibilities
- Engage private payers and surgeon offices to support favorable coverage decisions for individual aprevo® cases.
- Identify additional data needs to address private payer non-coverage positions and healthcare economics goals.
- Develop and implement a strategy for private payer engagement and monitor coverage issues to identify situations requiring direct engagement.
- Educate Sales team regarding Patient Access support activities and resources.
- Support ongoing activities involving third party coding hotline.
- Communicate with customers regarding proper coding and charging, based on CMS direction.
- Engage professional associations to elevate the issue of mis-coded claims and secure support for publication of coding alerts/updates.
- Communicate with non-customers about proper use of the ICD-10-PCS codes.
- Engage CMS as appropriate to provide updates on claims data and company efforts to educate hospital coding personnel through professional association involvement.
- Liaise with outside coding experts/legal representatives to ensure activities and guidance are up to date and compliant.
- Finalize NTAP application for cervical fusion and submit ICD-10-PCS X-code request.
- Develop strategy for outpatient/ASC utilization of aprevo cervical fusion devices and submit request for Transitional Pass-Through Payment to OPPS.
Qualifications
- Minimum: 10 years’ directly related experience.
- Certified Professional Coder (CPC®) certification required.
- Undergraduate degree required (preferred Masters) in a relevant area (Health Policy) scientific or business discipline.
- Preferred: 5 years agency experience and/or commercial insurance sector
- Demonstrated level of knowledge, confidence and executive presence to successfully engage and persuade private payers and hospital leadership.
- Comprehensive knowledge of Managed Markets/Market Access and how the various mechanisms of reimbursement influence customer buying decisions.
- Demonstrated capability and experience to educate others on how the company can proactively leverage opportunities and/or implement defensive plans in the face of health policy changes.
- A thorough understanding of U.S. healthcare delivery and payment systems, including public and private payer reimbursement mechanisms, clinical policies and pre-authorization processes.
- Understanding of relevant FDA and CMS guidelines, procedures and policies.
Skills
- Fluency in English
- Excellent oral/written communication and presentation skills,
- Strong computer software skills (MS Word, Excel, Outlook, PowerPoint, and Access experience)
- Ability to manage subordinates while independently performing high quality work
Equal Opportunity Employer
Carlsmed is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status. Carlsmed is committed to providing reasonable accommodations for candidates with disabilities in our recruiting process. If you need any assistance or accommodations due to a disability, please let us know.
Compensation
We are pleased to provide a competitive salary and benefits. Our benefits reflect our investment in the overall health and well-being of our employees and their families. including paying 100% of monthly healthcare, dental & vision insurance premiums, a 401(k) plan with employer matching and generous PTO. The expected pay range is: $150k-190k an hour. Compensation may vary based on related skills, experience, and relevant key attributes.