Director, Medical Policy
About The Position
Aerin Medical is focused on improving access to safe, practical, and effective treatments for people with ENT conditions. The Director, Medical Policy contributes to this mission by leading payer coverage initiatives for Aerin Medical products, with emphasis on regional payer coverage, relationship building, and collaboration with ENT state societies. The role engages influential leaders and key investigators to advance medical policy strategies. Reporting to the VP of Medical Policy and Reimbursement, the Director applies knowledge of CMS rule-making and future rate-setting methodologies, billing, coding, reimbursement across places of service, and payer policies. The role works with cross-functional teams and external consultants to address evidence gaps that could affect coverage decisions, and supports strategies to help payers consider favorable coverage for new procedure codes. The position requires up to 60% domestic travel.
Requirements
- Bachelor’s degree.
- Eight years of experience in market access and experience working with commercial payers on coverage initiatives.
- Track record of using product attributes, clinical evidence, and health economic considerations to develop compelling messages that influence coverage policy decisions.
- Broad knowledge of government and private payer reimbursement.
- Existing network of local market access stakeholders.
- Ability to analyze information and assess potential risk.
- Ability to assess the impact of payer policies.
- Ability to develop impactful strategies and action plans to mitigate reimbursement challenges.
- Ability to build collaborative relationships with relevant decision makers and Key Opinion Leaders.
- Ability to execute and influence reimbursement decisions.
- Strong written and verbal communication skills.
- Proficiency with PowerPoint, Excel, and Word.
Nice To Haves
- Billing and coding certifications.
- Experience in the ENT market.
Responsibilities
- Develop and execute medical policy and payer coverage strategies.
- Schedule meetings with payers to address non-coverage policies and collaborate with Key Opinion Leaders.
- Apply knowledge of the US payer landscape and CMS rule-making, including interpretation of rate files, addendums, cost statistic files, and facility billing methodologies relevant to future rate setting.
- Analyze market access trends, health policy changes, and health technology assessments.
- Map reimbursement requirements for Aerin Medical products by payer type and recommend targeted payers and strategic approaches.
- Identify and prioritize market access stakeholders who influence medical policy, including medical directors, governmental bodies, industry associations, and professional medical societies.
- Work with the VP of Medical Policy and Reimbursement to develop customer-facing materials communicating Aerin’s value proposition to payers and reimbursement-related stakeholders.
- Identify mutually beneficial partnering opportunities.
- Support the field market access team in finding opportunities to assist customers with billing and coding needs and provide resources to overcome access barriers.
- Assess individual customer reimbursement landscapes and educate customers about opportunities to engage payers in advocating for coverage.
- Collaborate with cross-functional teams and external consultants to address evidence gaps that may affect payer policy and coverage decisions.
Benefits
- Medical PPO and HSA plans with co-contribution.
- Dental insurance.
- Vision insurance.
- Accident insurance.
- Critical illness insurance.
- Hospital indemnity insurance.
- Onsite Tonal and Peloton.
- HSA/FSA.
- 401(k).
- Lifestyle Spending Account.
- Long-term disability insurance.
- Life insurance.
- Monthly stipend for phone and technology costs.
- Employee discounts.
- Weekly office lunches.
- Employee Assistance Program.
- Five free counseling sessions per issue per year.
- 80 hours of sick leave.
- 13 holidays.
- Flexible vacation for exempt employees.
- Career and Learning & Development opportunities, including Aerin-led leadership trainings.
- Aerin “give back” week, family days, and Aerin holiday giving.
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What This Job Offers
Job Type
Full-time
Career Level
Director
