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Director of Reimbursement and Payor Relations job in Washington

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Capstone Search Group jobs
Career Interest:  Accounting/Financial
Human Resources
Medical/Case Management
Insurance Discipline:  Life and Health
Managed Care
Job Type:  Full Time
State:  D.C. (DC)
City:  Washington
Washington, DC, USA (Show on map)

Leading advisory firm and clinical research organization to the neuro-musculoskeletal and orthopedic industry. A company with strategic vision and the focus to serve the medical device community. They offer the opportunity for professional growth through training programs, challenging assignments, and the opportunity to collaborate with great individuals. A supportive, experienced and collegial environment with people who value your experience and skills.

This organization currently seeks a Senior Manager or Director from a large health plan who is currently involved in coverage policy, reimbursement, clinical research and/or payor relations. We seek a high energy & dynamic professional who understands clinical utilities basis for determining coverage for medical technology oriented devices. In this role you will working as part of a collaborative team and will provide consulting services to the medical technology clients with respect to coverage, payment, and commercial market access. This will include things such as:

• Accountable for gaining and/or improving U.S. coverage with commercial payors specific to new and innovative technologies.
• Responsible for achieving favorable medical coverage policy and reimbursement agreements with both private payors and Medicare.
• Collaborate and design payor research to understand primary value drivers and requirements for early access and, post-approval, reimbursement for client products.
• Develop product value proposition and steering the development/updating of product value repositories (Health Economic models, value dossiers, commercial toolkits, etc).

Qualities, skills, and abilities we seek:

• 5+ years’ reimbursement related experience within the overall healthcare industry is required
• 3+ years of experience working with a major health plan as a Medical Coverage Policy Team Member or New Innovation Coverage Team Member, or related.
• Strong knowledge related to Governmental reimbursement regulations and changes to policies.
• In-depth understanding of payors, as well trends in pricing & reimbursement.
• Extensive experience with various account customer types and channels (e.g. HMO/PPO, Medicare D, Federal government, state Medicaid, PHS, HMO, and GPO).
• Solid understanding of how healthcare coverage, access and reimbursement works.
• Demonstrated capabilities in value-based pricing and value determination.

Salary:  $180,00 - $200,000
Bonus/Benefits:  Benefits Package

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