Reimbursement Manager

MTF Biologics

About The Position

MTF Biologics processes tissue grafts from human donors that are used in a growing array of clinical applications – positively affecting lives across the globe. As a global nonprofit organization that saves and heals lives by honoring donated gifts and serving patients, we collaborate with the medical, scientific, as well as organ and tissue donation communities. Our goal is simple–do what's right for patients, surgeons, tissue donors, and their families through our guiding principles. Reporting to the Senior Director of Health Policy and Government Affairs, the Reimbursement Manager will be responsible for the daily management of reimbursement support services of product portfolio. The incumbent will also act as the organization’s reimbursement liaison between sales staff and providers and must be willing to travel at least 30% of time with some weekend travel required.

Requirements

Bachelor's Degree
Degree In: Health Care Administration, Public Health, Public Policy, Public Administration, Finance, Business, Marketing, Communications or related field
Years of Experience: 3 - 5 years.
Minimum of 3-5 years of successful work experience in a related field e.g. tissue banking/tissue processing, medical device manufacturing, pharmaceutical or biologicals industry, healthcare reimbursement support services or health policy.
Possess a solid understanding of the Medicare and Medicaid programs and their payment methodologies including coverage development, coding, and reimbursement of allografts (e.g., tissue matrices/skin substitutes, musculoskeletal tissues, etc.,) used in wound care as well as in plastic & reconstructive and orthopedic procedures in all sites of care (e.g. physician offices and hospital outpatient & inpatient, and ASC settings).
Previous experience working with sales, marketing, clinical, regulatory, and research & development teams to support product launches and educate sales internal staff and external customers on current and future product coding and reimbursement.
Track record of developing and delivering product value through presentations to varied audiences for products with limited payer coverage & reimbursement.
Able to work independently with demonstrated self-initiative, capacity to research and stay current on managed care and healthcare industry trends.
Strong presentation skills with ability to articulate and present complex information in a simple and persuasive manner.
Outstanding problem solving, project/program management and organizational skills.
Demonstrated proficiency in MS Office (MS Word, Excel, PowerPoint, Outlook, etc.) software.

Nice To Haves

Preferred Certified Professional Coder (CPC), Certified Professional Biller (CPB), or Certified Billing and Coding Specialist (CBCS)
Experience with tissue matrices/skin substitutes used in wound care and surgical interventions as well as allografts used in plastic & reconstructive and orthopedic procedures.

Responsibilities

Support Senior Director of Health Policy and Government Affairs in fielding and responding to coding, coverage, and reimbursement internal inquiries and providing policy research assistance.
In coordination with sales and marketing staff, lead on-site customer meetings (e.g. physicians & hospital medical professionals, purchasing & revenue departments, billing/coding staff) to provide coding and reimbursement education & assistance and address any reimbursement challenges.
Manage third party reimbursement support services -- monitoring and analyzing casework for payer coverage trends and assisting with challenging cases and claims’ appeals.
Create internal educational materials and customer collateral (coding and reimbursement guides, etc.).
Prepare and submit Medicare Part B ASP data quarterly to CMS