The Reimbursement & Health Economics Manager at Penumbra is responsible for developing and communicating the clinical and economic value of the Penumbra Interventional Therapies portfolio of products.
In collaboration with the Penumbra sales organization, the Reimbursement Manager will differentiate Penumbra through direct interaction with clinical and economic customers that positively influences business objectives.
The R&HE Manager will provide fieldbased R&HE support to clinical and economic stakeholders (C-suite, hospital administration,
payers, and physicians), with a near-term focus of educating and supporting customers.
Specific Duties and Responsibilities
• Execute reimbursement, health economics, and value selling strategies to promote growth of the Intervention Therapies business towards Penumbra’s customers/stakeholders (C-suite, hospital administration, payers, and physicians).
• Build and maintain strategic working relationships with customers (C-suite, hospital administration, payers, and physicians) and develop economic key opinion leaders.
• Work in partnership with sales, strategic accounts & market access teams to plan and prioritize customer visits to deliver value selling messages.
• Collaborate with R&HE colleagues to provide insight regarding market intelligence and reimbursement trends and inform the development of customer-facing tools, economic models, and other tactical elements of reimbursement to facilitate patient access to Intervention Therapies.
• Educate and train sales team on health economic tools and messaging via in-person and virtual meetings.
• Develop relationships with physician champions to support interactions with hospital administrators and health plan decision-makers.
• Ensure health economic and value selling methodologies and messages are consistent and compliant with legal and regulatory guidance.
• Maintain expert level reimbursement knowledge (policies, coding, coverage, payment) for all Intervention Therapies therapies/products.
• Provide education and training to healthcare providers, office staff, and sales organizations on reimbursement processes, coding requirements, and billing procedures. Work in collaboration with legal, compliance, and other business groups to assure appropriate customer engagement processes are strictly adhered to.
• Assist healthcare providers to optimize reimbursement by ensuring accurate documentation and coding practices.
• Assist with appeal and denial management in cases where insurance claims are denied, or coverage is inadequate and help healthcare providers navigate the appeals process.
• Build and maintain relationships with political and policy stakeholders at the federal, state, and local levels to ensure that Penumbra is positioned as a key stakeholder in policy issues of importance to our business in the USA.
• Adhere to the Company’s Quality Management System (QMS) as well as domestic and global quality system regulations, standards, and procedures.
• Understand relevant security, privacy and compliance principles and adhere to the regulations, standards, and procedures that are applicable to the Company.
• Ensure other members of the department follow the QMS, regulations, standards, and procedures.
• Perform other work-related duties as assigned.
Position Qualifications
• Bachelor's degree with a focus in health policy, health economics, healthcare administration, or health services or related field with 5+ years of experience guiding Reimbursement & Health Economics strategies for a medical device manufacturer, or equivalent combination of education and experience
• Knowledge of US health care policy and payment systems, including Medicare and commercial payers, physician, and hospital reimbursement, for inpatient and outpatient sites of service.
• Ability to use financial calculators, excel and PowerPoint to demonstrate how Intervention Therapies products impact facility economics or healthcare system economically and financially.
• Ability to present complex health economic information to both large and small influential groups in a way that is credible, easy to understand and engages the audience.
• Ability to communicate and train healthcare providers and sales organization on reimbursement process and provide denial support.
• Experience educating clinicians and facilities on appropriate documentation and billing for innovative medical technologies.
• Good interpersonal skills with ability to develop relationships at all levels in an organization which impacts organizational business goals.
• Strong oral, written, and interpersonal communication skills
• High degree of accuracy and attention to detail
• Proficiency with MS Word, Excel, and PowerPoint
• Excellent organizational skills with ability to prioritize assignments while handling various projects simultaneously.
Working Conditions
• General office, and hospital environments
• Willingness and ability to work on site.
• Field based position with overnight travel estimated up to 50%.
• Potential exposure to blood-borne pathogens
• Requires some lifting and moving of up to 25 pounds
• Must be able to move between buildings and floors.
• Must be able to remain stationary and use a computer or other standard office equipment, such as a printer or copy machine, for an extensive period of time each day.
• Must be able to read, prepare emails, and produce documents and spreadsheets.
• Must be able to move within the office and access file cabinets or supplies, as needed.
• Must be able to communicate and exchange accurate information with employees at all levels on a daily basis.
Starting Base Salary is $120,000 to $170,000
Individual compensation will vary over time-based on factors such as performance, skill level, competencies, work location and shift.