Position Description: Reimbursement Manager

Job Title | Reimbursement Manager
Location | West, USA
Department | Reimbursement

Summary

This position is a critical front-line member of the Advanced BioHealing, Inc. Reimbursement team. The primary purpose of this role is to carry out supervisory responsibilities including interviewing and training department employees, planning, assigning and directing work; appraising performance; rewarding and disciplining employees, addressing concerns and resolving problems as well as communicating and implementing department reimbursement strategy for Advanced BioHealing, Inc. products.

Essential Duties and Responsibilities

• 1. Management Responsibilities:
  • Directly supervise Reimbursement Specialists in the Region assigned.
  • Carry out supervisory responsibilities in accordance with ABH’s policies and applicable laws.
  • Provides oversight and management of Reimbursement Specialist projects in assigned territory.
  • Establish relationships with sales representatives and customers to provide service in an appropriate, prescribed manner that utilizes proactive planning for individual accounts in support of department goals and the assigned Reimbursement Specialist.
  • Maintain current knowledge of reimbursement methodologies on national, regional and local level.
  • Alerts and informs Director, Reimbursement Operations of any policy or payment trending impacting current or potential customers.
  • Coordinate field sales training needs for both new and established sales reps. Develop, implement and monitor Reimbursement Specialist support of field sales representatives in assigned territories.
  • Plan and implements activities with sales representatives, prospective and new customers to understand potential for coding and coverage decisions to support positive reimbursement outcomes.  Make strategic consultative calls and address  reimbursement challenges as additional support to Reimbursement Specialists. 
  • Constantly evaluates and works with department personnel toward improving customer support.
  • Assists in management of customer accounts through review process of claims and/or reimbursement issues as identified by Reimbursement Specialists. 
• 2. Region Management
  • Responsible for submitting individual development goals, assigned territory business plan, monthly activity reports, and other reports in a timely manner as requested by the Director, Reimbursement Operations.
  • Support Director, Reimbursement Operations with implementation of department strategies as identified by department business plan.  
  • Coordinate development of reimbursement support and training materials with Director, Reimbursement Operations.
  • Demonstrate appropriate department planning and time management skills by effectively supporting Director in completion of required department projects.
  • Complete assignments as directed and in a timely manner. 
  • Meet or exceed the standard level of performance in territory management. 
• 3. Other Responsibilities
  • Provide sales support via distribution of materials and assistance to customers and sales representatives; work with Director, Reimbursement Operations to track and report on trends within territory; assist hotline staff in addressing coding, coverage or reimbursement resolutions, appeals for authorization and payment as directed. 
  • Complete assignments as directed and in a timely manner. 
  • Work collaboratively with the Government Affairs and Health Economics Department as appropriate.  Work well within a team-focused organization.

Supervisory Responsibilities

Directly supervises Reimbursement Specialists in defined Region.  Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

Qualifications

To perform this job successfully, individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Requirements

The skills, experience, and education required for this position include the following:

• 5+ years of commercial  collections and accounts receivable experience
• Ability to multi-task
• Good interpersonal and communication skills
• Candidates must be organized, personable, detailed, and team oriented
• Qualified candidate must have worked in high volume environment

Education and Experience

Bachelor's degree from a four-year college or university and 5 or more years of healthcare experience, including people management and leadership role.  A demonstrated ability to create and lead teams, direct goals, delegate responsibility and monitor progress coupled with evaluation against the goals.  Ability to read and analyze information and maintain sound judgment to make decisions.  Coding, coverage and reimbursement experience in device, pharmaceutical, and biotechnology a plus.  A Master’s degree in business, health care administration or public health preferred but may be waived due to experience and background. 

Specific experience/ skills needed include the following:

• Must have previous experience working with billing and medical claims personnel in various health care settings including, but not limited to a physician office, hospital, and ambulatory surgery center. 
• Minimum of five years management experience with expertise in coding, coverage and reimbursement.
• Must possess the ability to review health insurance forms [UB-4, CMS-1500, explanation of benefits, prior authorization forms], and provider encounter forms [superbills/charge tickets] in cases where billing, claims submission or documentation errors may occur. 
• Appearance is professional and appropriate for job position.

Language Skills

Ability to read, analyze, and interpret common scientific and technical journals, financial reports, and legal documents.  Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community. 

This position will interact routinely with internal customers including sales directors, sales representatives, product marketing and management, and occasionally with regulatory, clinical and finance departments.  Must be able to deliver presentations to large groups as requested by field sales in effort to provide reimbursement education to customers.

Mathematical Skills

Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. 

Reasoning Ability

Ability to define problems, collect data, establish facts, and draw valid conclusions.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This position is field based and may require as much as 30% travel.

We offer a competitive benefits & compensation package!

All qualified resumes should be submitted directly to careers@abh.com

We are an Equal Opportunity Employer.