Reimbursement Specialist

ResMed is a world leader in the development, manufacturing, and marketing of products for the diagnosis and management of sleep-disordered breathing (SDB). Our employees and distributors are located in more than 67 countries. At ResMed we are committed to providing an environment that fosters broad communication, focused work, and strong relationships. Innovative individuals and diverse teams have strengthened ResMed and will continue to spark growth. ResMed looks for people who want to be challenged and to be rewarded for meeting those challenges.

Employees at ResMed are the most important assets, so we offer a benefits package that promotes physical, emotional, and financial health for employees and their families. Our insurance plans and support programs cover the full spectrum of personal needs: medical, chiropractic/acupuncture, dental, vision, long-term care, life/AD&D, LTD/STD, EAP, 401(k), compensated time off, tuition reimbursement, gym, and massage.

 

This is a field position and candidates should be located near a major airport in either the Northeast, Southeast or West regions of the U.S.

 

SUMMARY

Plans and organizes reimbursement activities and strategy, providing support to sales team and customers to optimize profit and meet marketing, financial, and corporate growth objectives by performing the following duties.

 

Candidate must be familiar with ICD-9, CPT, and HCPCS coding, as well as NCDs and LCDs for CPAP and RAD devices.

 

Preferable candidate would have experience working with CMS and other government agencies or regulatory bodies.

 

Candidate must have at least 1 year of experience in a combination of marketing and reimbursement related fields.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

 

Manage, maintain, and monitor day-to-day activities of reimbursement hotline to ensure accuracy and cost-effectiveness.

 

Collaborate with a wide variety of functional areas such as sales, engineering, marketing, manufacturing, and operations to develop and provide reimbursement support responsive to customer needs and market opportunities.

 

Serve as liaison between the sales reps and the customer to identify and provide billing and reimbursement support to key external customers (i.e. physicians, clinicians, suppliers, sales representatives, payers)

 

Provide ongoing training to sales, marketing and reimbursement personnel.

 

Identify and define appropriate HCPCS codes for existing and new products.

 

Sets procedures for filing SADMERC verification and HCPCS code requests

 

Develop and maintain a prioritized list of customer and market reimbursement requirements.

 

Participate in the Research and Development process to identify reimbursement issues early on in the product development cycle and develop and implement a strategy for adequate reimbursement upon launch and beyond.

 

Work with senior staff to identify and develop key outcomes and reimbursement strategies for new and existing products. 

 

Complete strategic analysis of reimbursement issues from a global and national perspective.

 

Analyze governmental regulatory and reimbursement changes and their impact on company’s product line.   

 

Review competitive process and identify required competitive analysis.

 

Identify partnering opportunities with providers to gain presence with payers.

 

Assist in partnering with consultants, physicians, and specialty societies to establish relationships with major payers to educate them about company’s products and their role in the care continuum and to develop favorable coverage policies with these organizations.

 

Assist in developing and maintaining relationships with key opinion leaders, relevant medical societies, and policy-making entities to garner support for company’s technology.

 

EDUCATION and/or EXPERIENCE

Bachelor's degree (B. A.) from four-year college or university and one year related experience.

 

COMPUTER SKILLS

Proficient in MS Word, Power Point, Excel and Adobe Acrobat. Proficient in navigating the Internet and intranet as needed.

 

ResMed is an equal opportunity employer. (EOE)