Reimbursement Specialist - Northeast

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

Responsible for developing relationships with insurance payers and positioning ResMed products to ensure optimal reimbursement.

 

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

 

Take a leadership position in making the case for the value of SDB products in the healthcare continuum and work to change the paradigm from one of product cost to overall cost of care.

 

Work with Reimbursement Manager to develop strategic plan in targeting payers on a regional and national basis to set and achieve short term and long term goals.

 

Responsible for facilitating communication of pending coverage, coding and payment changes to major private payer polices to sales field in conjunction with Reimbursement Manager.

 

Market ResMed products to private insurance payers across the United States.

 

Increase coverage for sleep disordered breathing, including CPAP and bilevel devices.

 

Work with ResMed Partners, Territory Managers, and Regional Clinical Specialists to present ResMed products and the value of treating sleep disordered breathing to payers.

 

Attend industry tradeshows and conferences.

 

Identify and develop new private insurance payer contacts.

 

Coordinate with Senior Management, all levels of Sales and Sales Management, Marketing, New Business Development, Clinical, Finance, and Reimbursement to elicit feedback on payer coverage needs and develop effective tools and strategic plans. 

 

This position will work closely with the Sales, Reimbursement and Clinical departments to align efforts and execute plans.

 

This position will work closely with the Sales Division to uphold consistency, align and execute strategic directives.

 

Develop goals for each payer (both national and regional), reporting quarterly accomplishments and trends, in order to ensure the continued optimal coverage of ResMed products.

 

Generate and analyze intelligence necessary to communicate solid direction and leadership to the sales force as it relates to private payers.

 

Excellence in all forms of communication.

 

Establish, visit and preserve an active networking with private insurance payers.

 

Maintain extensive knowledge of reimbursement environments affecting product lines, including non-ResMed services.

 

Act with a sense of urgency in all pursuits.

 

Budget time and resources effectively.

 

60% travel

 

Motivated, execution and results focus with accountability for continuous self improvement.

 

Identification and development of new payer opportunities. 

 

QUALIFICATIONS

To perform this job well, an individual must be able to perform each essential duty successfully. The requirements listed below are representative of the knowledge, skills, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.Demonstrated knowledge and understanding of payer policies and Medicare coding, coverage, and payment.Understanding of national legislative initiatives affecting reimbursement of medical device products.Demonstrated ability to shift payers from an “acquisition cost” focus to a VALUE focus, as well as experience in leading others to this same understanding.

 

EDUCATION and/or EXPERIENCE

Bachelor's degree (B. A.) from four-year college or university; and a minimum of three (3) years successful experience in the insurance industry, or equivalent combination of education and experience. Previous experience calling on managed care contacts. Prior medical device experience highly preferred.

 

ResMed is an equal opportunity employer. (EOE)