United States » Director, Health Economics & Reimbursement

Director, Health Economics & Reimbursement

San Francisco, CA / San Jose, CA, US.

Other locations: Oakland, CA; Seattle, WA; Portland, OR, US.

Aortic stenosis impacts millions of people globally, yet it often remains under-diagnosed and under-treated. Edwards’ groundbreaking work in transcatheter aortic heart valve replacement (TAVR) pioneered an innovative, life-changing solution for patients by offering heart valve replacement without the need for open heart surgery. Our Transcatheter Heart Valve (THV) business unit continues to partner with cardiologists and clinical teams to transform patient care with devices supported by clinical evidence. It’s our driving force to help patients live longer and healthier lives. Join us and be part of our inspiring journey.

The Director, Global Health Economics and Reimbursement is a field based role responsible for working directly with hospital executives, cardiovascular service line leaders and physicians to ensure they recognize the economic and clinical value of the transcatheter heart valve (THV) therapy. They will work directly with hospital leaders and physicians to deliver hospital economic analyses customized to each provider. This individual will also support the health care providers in obtaining optimal reimbursement (payment rates and market access) by serving as a knowledgeable resource in coding, coverage and payment, as well as, an intermediary to payers including Center for Medicare Services (CMS) and/or Medicare Administrative Contractors (MAC), Medicaid, Veteran Affairs (VA) and commercial payers.

The Director, Global Health Economics and Reimbursement will be located in and support Northern California, Washington, and Oregon, and will report to the VP US Field, Global Health Economics and Reimbursement.

How you will make an impact:

  • Ensure THV value messages are consistently developed and delivered, and customer feedback on value proposition is communicated to internal THV leadership. This will necessitate a competence in developing, synthesizing, and presenting health economic analytics.
  • Establish and maintain effective working relationships with key stakeholders at hospitals engaged in THV procedures, including hospital executives, cardiovascular administrators, quality, finance, documentation integrity, billing, and physicians (interventionists and surgeons), to support the site in establishing and maintaining a THV program through the development and implementation of reimbursement plans (coding, coverage, payment) unique to each provider.
  • Ability to articulate a thorough understanding of the structural heart landscape, trends and market insights. A strong understanding of the commercial and government payor landscape including coverage policies and payment processes. This will include managing and addressing coverage policy issues with payors as necessary.
  • Mastery of health economic and quality content: billing, coding, payment, coverage, policy, hospital finances, structural heart program innerworkings, cath lab and OR processes, clinic and procedural expertise, etc.
  • Ability to identify needed additional expertise and quickly assimilate information and communicate trends, clinical research, policies, etc and how they will impact TAVR/SH business. Identifies market trends and customer needs and supports development of strategies and resources for their customers and team.
  • Effectively able to manage demands and needs of multiple programs and customers. Provide high touch program support and build access to key leaders within each organization.
  • Build a strategic relationship and serve as a supporting role to our aligned business partners including sales, marketing, government affairs, and medical/clinical affairs.
  • Assist our Regional and Territory Sales Managers in the development, implementation, and managements of strategic initiatives within geography.
  • Ability to travel up to 50% of the time within the geography to support programs and for internal meetings and conferences.
  • Perform other duties and responsibilities as assigned.

What you’ll need (Required):

  • Bachelor’s Degree or equivalent in a life science, health economics, health policy, or related field with related experience and 12+ years of experience in health policy, health economics, medical device reimbursement and technology assessment OR Master’s Degree and 10+ years of experience
  • Minimum of 5 years of work experience in a field base, consultative, or administrative role within the healthcare industry. Reimbursement and/or sales experience preferred.
  • Understanding of medical and clinical research methods and publication interpretation with ability to use evidence to support value proposition.
  • Strong business acumen, analytical skills, and experience working with various internal business partners (especially Sales, Marketing, Clinical, Regulatory, Legal, and Government Affairs staff) to provide insight into key economic and reimbursement issues for transcatheter heart valve products.
  • Mastery of health economic and quality content: billing, coding, payment, coverage, policy, hospital finances, structural heart program innerworkings, cath lab and OR processes, clinic and procedural expertise, etc.

What else we look for (Preferred):

  • Strong understanding of the commercial insurance landscape and relevant reimbursement processes. A solid understanding of public payer programs; e.g. CMS, including coverage, coding, and payment policies.
  • Ability to build and maintain strong relationships with hospital leaders and physician customers.
  • Proficient in Microsoft Office Suite (i.e. Excel, PowerPoint, Word, Outlook).
  • Excellent interpersonal skills, written and verbal communication skills, especially presentation development and delivery in person and virtually. ust be confident, articulate and have professional speaking abilities.

Aligning our overall business objectives with performance, we offer competitive salaries, performance-based incentives, and a wide variety of benefits programs to address the diverse individual needs of our employees and their families.

For California and Washington, the base pay range for this position is $166,000 to $235,000 (highly experienced).

The pay for the successful candidate will depend on various factors (e.g., qualifications, education, prior experience).  Applications will be accepted while this position is posted on our Careers website.

This job is posted by Edwards Lifesciences.

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