Field Reimbursement Manager

Company Description Reprise Biomedical, Inc. is focused on the development and commercialization of biologic medical devices utilizing a proprietary perfusion decellularization process that delivers superior clinical outcomes in a wide variety of surgical procedures. The company is dedicated to innovation creating devices that address unmet surgical needs. Its flagship product, Miro3D wound matrix, expands the wound management portfolio with a unique three-dimensional solution designed for deep and tunneling wounds.

Role Description The Field Reimbursement Manager is a full-time role responsible for creating the overarching strategy for reimbursement and market access for the company’s products and expanding the company’s payer and provider network across local, regional, national, and governmental levels.

Day-to-Day Responsibilities

• Coordinating with the company’s third-party reimbursement resources and serving as the primary field liaison to provide timely and accurate responses to the sales team and their customers on questions regarding payer policies, coverage rules, and reimbursement processes for wound care products and services.
• Explaining prior authorization requirements, coding, billing, and appeal processes specific to wound care therapies.
• Monitoring and facilitating the resolution of coverage denials, prior authorization delays, and reimbursement barriers for wound care treatments with the assistance of third-party reimbursement resources.
• Ensuring reimbursement support is consistent with payer requirements, company policies, and applicable laws. Reinforcing that benefit verification or prior authorization does not guarantee coverage or payment and that final coverage and payment decisions remain with the payer.
• Ensuring outside reimbursement resources guide providers through appeals and documentation improvements to secure coverage.
• Creating a strategy and tactics for optimizing coverage by working with internal and external partners to best package and position existing evidence and data.
• Identifying clinical and evidence gaps related to emerging coverage requirements for our medical devices.
• Ensuring the organization can clearly deliver the medical device value message to the payer community. Clearly understanding the current reimbursement methodology and recommending changes needed to obtain best possible access for patients.
• Identifying and implementing opportunities to collaborate with Payers where possible.
• Building relationships with key major medical societies who help drive treatment guidelines. Understanding how those guidelines influence payer decisions.
• Coordinating with marketing and other functions on the development and oversight of reimbursement tools and support programs including digital, social, collateral, support, customer hotlines, education programs, etc.

Qualifications

• Knowledge of reimbursement of skin substitutes for wound care is strictly required.
• Four years of experience in reimbursement, market access, or payer relations with a strong understanding of medical delivery systems, reimbursement, market access conditions and health policy trends that impact medical device and procedural coverage in the US.
• The ability to navigate payer networks, especially in scenarios where the network is closed, and successfully gain approval.
• Experience with medical billing and coding processes, including claims submission, denials management, and documentation requirements.
• Exceptional attention to detail, particularly regarding contract compliance and accuracy in documentation.
• Bachelor’s degree in health policy, finance, business, or a related field, or equivalent practical experience.

The compensation range of $90,000-$130,000 represents a good faith estimate of what we expect to pay for the role based on current market conditions, the responsibilities of the position, and the qualifications of the ideal candidate. While we strive to offer competitive compensation, it is important to note that offers are typically made withing the range but not at the top. The final offer will be determined based on the candidate's skills, experience, another relevant factors.

We are interested in every qualified candidate who is eligible to work in the United States. However, we are unable to sponsor visas both currently and in the future.