Job Description

Job Description

Job Description

Salary:

Location: USA

General Summary

MolecuLight is a leading Device manufacturer dedicated to providing innovative and high-quality solutions to improve patient access and reimbursement for medical services. We are currently seeking a skilled and experienced Senior Manager Field Reimbursement to join our team. This key role will focus on managing onboarding of new buy and bill customers and as well as driving claims appeal support as needed with existing customers. As Senior Manager Field Reimbursement, you will be responsible for executing the MolecuLight market access business plan pertaining to the assigned geography. Your primary objective will be to ensure customers have a seamless reimbursement experience when purchasing and billing MolecuLight claims to all payer types.

The successful candidate will fit the MolecuLight values :

• Merit and results-based recognition and advancement
• Find how we can, not why we cant
• Build value for customers and investors
• Innovation without ego
• Continuous improvement
• Achieve results with a sense of urgency
• Avoid bureaucracy that adds no value to our customers

Key Accountabilities and Responsibilities

FRM will support Field Sales Customer onboarding efforts nationally

FRM must be able to analyze claims and policy data and know how to translate that data into actionable adoption steps during live Provider interactions to support Provider utilization

Superb knowledge and operationalizing experience using internal HUB model with ability to customize resources consistent with early-stage commercialization

• Account Management Lead:

Provider and account interface will be a key focus as the FRM has responsibilities to build relationships with, proactively educate, and ensure both providers and their staff are educated on payer and reimbursement policies and procedures.

• Reimbursement Strategy Development:

Design and execute comprehensive reimbursement strategies that align with company objectives and enhance market access for products and services.

Analyze market trends, payer policies, and regulatory changes to identify opportunities and threats to reimbursement efforts.

• Collaboration and Communication:

Partner with internal stakeholders, including sales, marketing, and product development teams, to communicate reimbursement-related updates and strategies.

Build and maintain relationships with healthcare providers, payers, and third-party administrators to facilitate reimbursement processes.

• Problem Solving and Support:

Provide expert reimbursement support to healthcare providers, assisting them with claims submissions, prior authorizations, and appeals processes.

Act as a key point of contact for field reimbursement inquiries from stakeholders, resolving issues promptly and effectively.

• Data Analysis and Reporting:

Monitor and analyze reimbursement metrics, trends, and outcomes to assess the effectiveness of reimbursement strategies and initiatives.

Prepare and present reports to senior leadership, highlighting successes, challenges, and recommendations for improvement.

• Compliance and Best Practices:

Ensure that all reimbursement processes comply with applicable laws, regulations, and industry standards.

Establish best practices for reimbursement processes and actively work to streamline operations.

Knowledge, Skills, and Experience RequiredEducation:

• BA/BS Degree, and at least 5 years of pharma, biopharmaceutical, and/or medical device experience calling on field-based customers with a demonstrated successful track record
• CPC Certification is necessary for this position

Knowledge and Experience:

• Account Management and/or Reimbursement experience working in the provider office and HOPD setting, building strong customer relationships

5-7 years Buy/Bill experience in Medical-Surgical space is preferred

• Category 3 CPT Code billing experience is a plus
• Candidate should have experience in billing in multiple places of service ranging from HOPD to SNF across various Provider specialties
• Previous experience managing and sustaining customer interactions required
• Knowledgeable on Medicare billing/coding and appeal process
• Broad understanding of Medicare EOBs and CMS 1500 forms
• Solid understanding of HTA coverage policy creation, interpretation, and management
• Superior verbal, written, and presentation skills to effectively convey strategic and technical market access information, with an ability to condense complex information into concise outputs and direction
• Ability to balance external stakeholders wants with MolecuLight needs
• Demonstrated ability to work with multiple stakeholders in a collaborative and constructive manner
• Significant travel involved
• Management reserves the right to change or modify such duties as required
• Please submit your resume and a cover letter detailing your relevant experience and why you are interested in this position.

Disclaimer

The above information on this job description and specification has been designed to indicate the general nature and level of work performed within this job. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required.

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