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Senior Strategic Reimbursement Consultant

Jul 11, 2022

SENIOR STRATEGIC REIMBURSEMENT CONSULTANT

PRIA Healthcare provides solutions to support medical device reimbursement. We believe patients deserve to have access to—and insurance coverage for—the most innovative and scientifically proven medical devices, treatments, and procedures.  Our services are focused at removing barriers throughout all stages of a products lifecycle-from concept, to clinical evaluation, through to commercialization. 

To ensure that we are providing the most comprehensive solutions to support the needs of our customers and their patients, we are expanding our team to include a new Strategic Reimbursement Consulting Division of the company.  We are actively searching for a Senior Level Consultant to be responsible for developing and executing strategic solutions to ensure our client’s technologies and services are appropriately represented in the healthcare marketplace including the establishment of medical necessity with the payer community, appropriate procedure and device coding, and ensuring adequate payment for all key stakeholders. 

Responsibilities:

  • Develop and execute comprehensive solutions to remove barriers to coverage, coding, and payment for PRIA’s clients
  • Set and meet aggressive commitments to achieve company business goals and objectives through the development and management of a portfolio of consulting engagements
  • Complete and submit coding application including CPT®, HCPCS, and ICD-10
  • Develop and deliver payer facing materials to establish medical necessity including presentations, policy development, dossiers, and technology briefs
  • Play a key role in the continued development of the company’s leading-edge consulting service line
  • Develop financial support tools to highlight the economic value proposition of client technologies and procedures
  • Develop and maintain relationships with key decision makers at public and private payers along with other key associations on reimbursement and health policy issues including AdvaMed, MDMA, Professional Medical Societies, etc.
  • Provide expertise and support as needed to the PRIA Patient Access teams
  • Prepare and deliver educational seminars

Required Qualifications:

  • 5+ yrs. medical device/DME consulting experience with successful strategy and execution experience
  • Experience influencing external stakeholders such as payers, physicians, hospitals, and CMS, with impactful reimbursement and outcomes planning initiatives across multiple clinical specialties, geographies, and manufacturers
  • Familiarity with all U.S. coding systems including HCPCS, ICD-10, and CPT
  • Understanding of all U.S. provider payment systems
  • Understanding of U.S. government and commercial payer policy development including commercial plans and the LCD/NCD process
  • Experience submitting for new CPT codes
  • Understanding of process to achieve alternative payment for new technologies including NTAP, TPT, and New Technology APC assignment
  • Experience researching and understanding industry trends, risks, and changes that may impact our customer’s position in the healthcare marketplace
  • Superior written and verbal communication skills

Preferred:

  • Professional Society and Payer relationships and past collaborative experience
  • Experience interacting with the CSUITE needs of healthcare clients to support procedure economics and decisions
  • Proven ability to work independently, as well as collaboratively within team structures
  • Accreditation through AAPC, RHIA, or AHIMA
  • Experience being part of an integrated team to represent health economic endpoints through regulatory affairs and clinical trial development
  • Entrepreneurial spirit and excitement toward promoting PRIA’s new Consulting Services

 Additional Information:

  • The successful candidate must not be subject to employment restrictions from a former employer (such as a non-compete) that would prevent the candidate from performing the job responsibilities as described
  • This is a remote position open to candidates across the U.S.

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