Manager, Payer Compliance

Tactile Medical•Minneapolis, MN

About The Position

At Tactile Medical, we specialize in developing at-home therapy devices to treat lymphedema, chronic venous insufficiency and respiratory illnesses. The Manager, Payer Compliance is responsible for managing payer audit activity to ensure compliance with payer policies and government regulations. This role ensures payer requirements are implemented within the order process to meet payer compliance standards, optimize reimbursement and ensure access to Tactile Medical’s products. Key responsibilities include managing payer audits and appeals, analyzing payer rules, resolving issues, reporting data and analytics, collaborating with internal/external stakeholders, and providing input to develop and improve payer requirements.

Requirements

Education: Bachelor’s degree in Business, Healthcare Administration, or a related field (or equivalent experience).
Experience: Minimum 3+ years of leadership experience managing teams or direct reports.
Proven experience in payer audits, appeals, and reimbursement processes.
Strong understanding of payer methodologies, including coding, coverage criteria, medical terminology, and denial resolution.
Skills: Excellent analytical and problem-solving abilities; able to leverage data for decision-making.
Strong communication skills for interacting with internal teams and external payer contacts.
Ability to manage cross-functional collaboration with compliance, finance, and operations teams.
Technical: Proficiency in reporting tools and dashboards for audit and appeal outcomes.
Familiarity with regulatory requirements (e.g., HIPAA).

Nice To Haves

Experience: 5+ years in payer policy analysis, audit management, or healthcare reimbursement.
Previous experience in medical device industry, health insurance, or healthcare operations.
Knowledge: In-depth understanding of Medicare and commercial payer policies, including NCDs and LCDs.
Familiarity with fraud, waste, and abuse audit trends and pre-payment review cycles.
Skills: Advanced ability to develop strategic solutions for coverage challenges.
Experience creating educational resources for internal teams and external stakeholders.

Responsibilities

Ensure compliance with all payer requirements.
Responsible for leading team members charged with the submission of audit responses and associated appeals to commercial and public payers.
Research, interpret, and stay current on payer policies, guidelines, and regulatory changes from commercial, government, and other payer types.
Provide input for the creation and refinement of internal policies and processes to align with payer standards and industry best practices.
Provide regular updates to stakeholders on audit performance and policy changes, escalating unresolved issues as needed.
Responsible for driving process changes and identifying ways to improve coverage positions through payer audit analysis and appeal arguments.
Develop and utilize dashboards and reporting tools to evaluate audit outcomes and to measure effectiveness of changes to payer requirements.
Guide and oversee appropriate training and education for multiple stakeholders including operations, sales force, patients, and clinicians.
Work collaboratively with all levels of personnel and management to meet company goals.
Assess departmental capabilities and monitor staff performance to ensure highest output.
Participate and lead project initiatives, as assigned.
Maintain compliance with all appropriate regulatory requirements including HIPAA.
Other duties as assigned.