Director, Field Health Economics and Reimbursement

Edwards Lifesciences-posted 11 days ago
Full-time • Director
Miami, FL
5,001-10,000 employees
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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 reside in either Florida, South Carolina, or North Carolina and support field activity in those markets. The role will report to the Sr. Director East, Global Health Economics and Reimbursement.

  • 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.
  • 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.
  • Understand 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. Identify needed additional expertise and quickly assimilate information and communicate trends, clinical research, policies, etc. and how they will impact TAVR/Structural Heart business.
  • Identifies market trends and customer needs and supports development of strategies and resources for their customers and team.
  • 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 management of strategic initiatives within geography.
  • Perform other duties and responsibilities as assigned.
  • Bachelor's Degree or equivalent in a life science, health economics, health policy, or related field plus 12 years of experience in health policy, health economics, medical device reimbursement and technology assessment or master’s degree plus 10+ years of related experience, or equivalent work experience based on Edwards criteria.
  • Basic understanding of medical and clinical research methodologies, including the ability to interpret scientific publications and apply evidence to support product value propositions.
  • Demonstrated business acumen and analytical thinking, with experience collaborating cross-functionally with teams such as Sales, Marketing, Clinical, Regulatory, Legal, and Government Affairs to address economic and reimbursement considerations.
  • Foundational knowledge of health economics and reimbursement, including familiarity with billing, coding, payment systems, coverage policies, and hospital financial operations related to structural heart programs and procedures.
  • Ability to travel up to 50% domestically
  • Minimum of 5 years of work experience in a field based, consultative, or administrative role within the healthcare industry.
  • Reimbursement and/or sales experience.
  • 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.
  • Must be confident, articulate and have professional speaking abilities.
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