Marlborough, MA, US.
Join a highly visible and influential team in a well-established medical device industry leader to strategize reimbursement opportunities. The Health Economics and Market Access (HEMA) Manager I supports Boston Scientific’s rapidly growing Endoscopy (Endo) division. A fundamental priority for this position will be executing HEMA strategy through collaboration with multiple functional areas including Marketing, Sales, Clinical, Medical Affairs, Legal, and Regulatory. This role encompasses the range of health economic, market access and reimbursement strategy and tactics for the Endo product portfolio at Boston Scientific including, but not limited to, core biliary, enteral feeding, and airway franchises.
We are seeking a strategic leader for the U.S. market to develop, lead and implement HEMA strategies and initiatives, creating patient access and meaningful health economic and reimbursement support tools for existing and emerging technologies. The successful candidate will have experience in medical device strategic reimbursement and market access, facility and physician reimbursement, U.S. healthcare and payment policy, and public and private payors. Prior collaboration with medical societies, AMA CPT, government affairs and trade associations is a plus. Outstanding communication skills are required with the ability to assess, create, and convey complex reimbursement strategies to senior management, customers, physicians, medical societies, trade associations, payors and payor intermediaries.
Your responsibilities will include:
- Lead the planning, development, execution, and maintenance of health economic, market access and reimbursement activities by collaborating with divisional staff and key internal/external stakeholders in support of business objectives. These include all aspects of coding, coverage, and payment related activities for both upstream and downstream products.
- Work with new product development teams to ensure health economics and market access needs are incorporated into product development plans and timelines; ensure all necessary new product development deliverables are completed on time and on budget.
- Assess reimbursement opportunities and challenges facing the division’s emerging technologies and commercially marketed products and communicate business impact to senior management.
- Support and participate in evidence generation activities from HEMA, clinical, medical affairs, and R&D programs.
- Collaborate closely with multiple cross functional partners to develop product value propositions early in the product development lifecycle.
- Partners with regional HEMA and commercial teams to identify evidentiary requirements, deliver customizable tools, provide necessary training and education, address local Health Technology Assessment (HTA) requirements, and remove potential barriers to access.
- Works with specialty societies, payors, and key opinion leaders to provide functional expertise and leadership, product positioning, advocacy and thereby actively contributing to overall business goals and objectives.
- Provide virtual and/or on-site reimbursement support to key external stakeholders (e.g., hospitals, clinicians, investigator sites, , etc.) as appropriate.
- Provide appropriate in-service training to divisional functions (e.g., sales, marketing, R&D, clinical, regulatory, legal) to increase awareness and understanding of health economics and market access competencies and their role in supporting a product’s success.
- Implement and manage activities required to achieve health economics and market access strategic objectives (e.g., new code applications, customer billing guides, and other external-facing educational tools).
- Monitor policy developments that impact the reimbursement of products and/or procedures that utilize BSC products.
- Build relationships in key markets with government, physician, hospital, and third-party payor decision makers.
- Bachelor’s degree in healthcare reimbursement, health economics, healthcare delivery and/or administration, health policy, public health, or similar discipline
- Minimum 5-years working in the delivery and/or administration of healthcare, healthcare payor, or the medical device industry.
- In-depth knowledge and understanding of the healthcare industry and healthcare systems.
- Experienced and knowledgeable regarding CMS/Medicare policies and processes including an in-depth understanding of the Physician Fee Schedule (PFS), the Outpatient Prospective Payment System (OPPS), the Ambulatory Surgery Center Payment System (ASC), and the Inpatient Prospective Payment System (IPPS).
- Working knowledge of CPT codes, Relative Value Units (RVUs), HCPCS codes, Ambulatory Payment Categories (APCs), Medicare Severity-Diagnosis Related Groupings (MS-DRGs) and ICD-10 diagnosis and procedure codes.
- Familiarity of reimbursement dynamics by site of service specifically regarding medical device procedures in non-hospital facilities (e.g., ASC, physician office, office-based labs, etc.) compared with hospital facilities (hospital inpatient, hospital outpatient)
- Working knowledge of answering health economic questions using large datasets
- Working knowledge of hospital financial systems and revenue cycle management practices
- Management experience leading functional and cross-functional teams
- Demonstrated ability to make effective decisions independently and to work in a fast-paced matrix environment with minimal supervision.
- Demonstrated skills in prioritizing and managing multiple programs and projects
- Demonstrated ability to meet statutory deadlines related to payor payment and policy strategy.
- An advanced degree such as an MBA, MPH, MHA, MS, MSc in health policy, health economics, healthcare administration, health services research, public health or similar discipline is highly desired.
- Direct experience in gastroenterology or pulmonary specialties
- Outstanding inter-personal skills including developing relationships at all levels in an organization and directly influencing business objectives.
- Ability to present complex health economic information to both large and small influential groups in a way that is both easy to understand, credible, and engages the audience.
- Effectively use economic tools to demonstrate to customers how Boston Scientific products will impact their facility or healthcare system economically and financially.
- Experience working as part of both functional and cross-functional teams.
- Certification in Medical Coding (CPC, CCS-P, CMC, COC)
Requisition ID: 576943
Diversity – Innovation – Caring – Global Collaboration – Winning Spirit – High Performance
At Boston Scientific, we’ll give you the opportunity to harness all that’s within you by working in teams of diverse and high-performing employees, tackling some of the most important health industry challenges. With access to the latest tools, information and training, we’ll help you in advancing your skills and career. Here, you’ll be supported in progressing – whatever your ambitions.
As a leader in medical science for more than 40 years, we are committed to solving the challenges that matter most – united by a deep caring for human life. Our mission to advance science for life is about transforming lives through innovative medical solutions that improve patient lives, create value for our customers, and support our employees and the communities in which we operate. Now more than ever, we have a responsibility to apply those values to everything we do – as a global business and as a global corporate citizen.
So, choosing a career with Boston Scientific (NYSE: BSX) isn’t just business, it’s personal. And if you’re a natural problem-solver with the imagination, determination, and spirit to make a meaningful difference to people worldwide, we encourage you to apply and look forward to connecting with you!
At Boston Scientific, we recognize that nurturing a diverse and inclusive workplace helps us be more innovative and it is important in our work of advancing science for life and improving patient health. That is why we stand for inclusion, equality, and opportunity for all. By embracing the richness of our unique backgrounds and perspectives, we create a better, more rewarding place for our employees to work and reflect the patients, customers, and communities we serve. Boston Scientific is proud to be an equal opportunity and affirmative action employer.
Boston Scientific maintains a prohibited substance free workplace. Pursuant to Va. Code § 2.2-4312 (2000), Boston Scientific is providing notification that the unlawful manufacture, sale, distribution, dispensation, possession, or use of a controlled substance or marijuana is prohibited in the workplace and that violations will result in disciplinary action up to and including termination.
Please be advised that certain US based positions, including without limitation field sales and service positions that call on hospitals and/or health care centers, require acceptable proof of COVID-19 vaccination status. Candidates will be notified during the interview and selection process if the role(s) for which they have applied require proof of vaccination as a condition of employment. Boston Scientific continues to evaluate its policies and protocols regarding the COVID-19 vaccine and will comply with all applicable state and federal law and healthcare credentialing requirements. As employees of the Company, you will be expected to meet the ongoing requirements for your roles, including any new requirements, should the Company’s policies or protocols change with regard to COVID-19 vaccination.
This job ad will be unpublished on 23/02/2024.
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