Senior Manager, Field Reimbursement
SetPoint Medical
full-time
Posted on:
Location Type: Hybrid
Location: Valencia • California • United States
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Salary
💰 $125,000 - $175,000 per year
Job Level
About the role
- Lead and manage a team of field reimbursement specialists to support rheumatology, surgical practice and hospital/ASC value analysis and reimbursement outcomes.
- Develop reimbursement/value analysis messaging platforms, including presentations and economic value, as well as customer support models for claim payment issues.
- Serve as an executive-facing subject matter expert for value analysis committees, supply chain leaders, and clinical stakeholders.
- Identify payment trends and build analytics to support our value proposition.
- Provide claims support and follow-up, including claim review, denial analysis, appeal strategy, and payer communication.
- Educate customers on appropriate coding, billing, and documentation requirements for device-related procedures.
- Complete corporate administrative and training requirements on time and accurately.
- Maintain company standards involving ethical and moral character, and always represent the company with the highest professional standards.
Requirements
- At least 4 years’ experience working in medical device reimbursement, market access, healthcare consulting, accounts receivable or claims follow-up in a medical device company, healthcare provider, or third-party billing service provider.
- Ability to manage workload, delegate and build teams, either with direct reports are in a matrixed organization
- Experience with claims follow-up for commercial and governmental payers
- Awareness of, or ability to quickly learn, the medical policy and coverage landscape for vagus nerve stimulation.
- Knowledge of the claims appeal processes that include electronic and paper claim appeals and external review, ALJ.
- Experience with HIPAA compliance standards for covered entities.
- Understanding of hospital billing workflows, ancillary systems (OR systems, materials master files, charge routers, etc.) and ability to learn and use IT systems such as EPIC, Cerner, etc.
Benefits
- Health insurance
- 401(k) matching
- Paid time off
- Flexible work arrangements
- Professional development opportunities
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
medical device reimbursementclaims follow-updenial analysisappeal strategycodingbillingdocumentation requirementsclaims appeal processesHIPAA compliancehospital billing workflows
Soft Skills
team managementdelegationworkload managementcustomer educationcommunicationleadershiporganizational skillsprofessional standards