Director, Reimbursement & Government Affairs

 

The Director, Reimbursement & Government Affairs supports Mölnlycke Health Care’s (MHC) United States (US) market by implementing the commercial platform for reimbursement solutions  as well as  federal policy and legislation, i.e.: CMS Value Based Programs (Hospital Acquired Conditions, Readmissions, Value Based Purchasing, IMPACT Act).  Primary focus for this role, will be to develop strategy and execution tactics and actions to ensure national and local reimbursement through evidence based outcomes, clinical and health economics; focused on coverage, coding and payment for current portfolio solutions and future launches.  Additional focus will be expanding public policy with Capitol Hill, Health & Human Services and Industry Advocacy Organizations (NPIAP, AAWC, AORN, WOCN, SHM),  to positively impact reduction of pressure Injuries & hospital / community acquired infections.

KEY ACCOUNTABILITIES

Reimbursement

  • Lead all Reimbursement activities for the US business
  • Under direction of the Vice President, is responsible for developing strategy and executing Durable Medical Equipment applications, coding for product solutions as appropriate (HCPCS), as well interfacing with Government (Medicare, Medicaid, Managed Medicare and Medicaid (example Centene), Durable Medical Equipment Carriers such as Palmetto, and Commercial Payers (Aetna, Anthem, Cigna, Humana, Kaiser, United Healthcare).
  • Collaborate with Internal global stakeholders on policy issues, new business development, and leverage of global and US initiatives such as, Hospital Acquired Infection (HAIs), Community Acquired Infection (CAI), Surgical Site Infection (SSIs), along with Standardization and Utilization.
  • Leads development and implementation customer strategies and monitor projects supporting field pull through.
  • Monitor, analyse commercial, Medicare, and Medicaid payer market and develop strategy with senior management.
  • Develop and execute pull-through strategies on CMS Value Based Programs
  • Increase organizational competency through training and development venues on payer landscape and reimbursement trends.
  • Keep current on marketplace health care issues/strategies, customer issues/trends and best practices
  • Analyse, evaluate, and apply for reimbursement codes with both CMS for new coding as well as PDAC – HCPCS coding for new and existing MHC products HCPCS

Government Affairs

  • Lead all Government Affairs activities for the US business
  • Develop and advocate policy and technical regulatory positions on pressure ulcer / injury prevention, hospital-acquired infections, reimbursement, and value based programs, IMPACT ACT.
  • Establish and maintain relationships with HHS, CMS, CMMI, AHRQ and CCSQ, VA DoD officials .
  • Additional responsibilities include where appropriate, include but are not limited to: Capitol Hill public policy activities with key opinion leaders (RN, MD, PhD advocates), solution requests meetings with Members of the U.S. House and Senate for specific disease state / prevention and treatment areas.

Sales Excellence

  • Execute on ACA / ACHA & CMS for Customer Messaging with field sales, Strategic Accounts, Health Economics Solutions Team and Marketing.
  • Collaborate with internal stakeholders to translate and develop tools and customer facing messaging on quality initiatives, such as the Value Based Purchasing, Readmissions Reduction Act and IMPACT Act.
  • Develop & facilitate training curriculum, on MS-DRG, DMEPOS / PDAC, HCPCS, IPPS and OPPS, ASC, LTCAH, and SNF coding, coverage and reimbursement
  • Reimbursement -  Establish collaborative “C” Suite partnerships with payers, channel players, and hospital systems
  • Government Affairs - Responsible for advocating for best patient outcomes with Members of the U.S. House and Senate .
  • Sales Excellence - Collaborate with internal stakeholders to translate and develop tools and customer facing messaging

COMPETENCIES

  • Coding, Coverage and Payment experience, with documented success in gaining approval for reimbursement codes in the medical device marketplace
  • Ability to influence and communicate the ACA / Medicare and VA / DoD policies and mandates for acute and post-acute setting for WC and SUR
  • Demonstrated “C” Suite Platform Skills – verbal, written and translatable
  • Senior leadership responsibilities and experiences in developing “C” Suite and Government Official Relationships

QUALIFICATIONS AND EXPERIENCE

  • Bachelor’s degree within business administration, health economics, health / government affairs and public policy, health care administration, or related field required from accredited college/university; 
  • Advanced degree preferred; MSA, MPH, MBA, etc.
  • At least 5+ years of demonstrated medical device or pharmaceutical experience in coding, coverage and payment with payer relations
  • Government Affairs, VA & DoD, Indian Health Services, and other government entity experience is a plus
  • Experience in representing company objectives to payers & government stakeholders
  • Demonstrate excellent platform skills: including written and verbal communication, business acumen; and collaborating with internal and external stakeholders at the “C” Suite level
  • Experience working through US reimbursement challenges, including change management to payment policies
  • Experience presenting to “ C” Suite level customers, field sales, Strategic Accounts, Leadership Team members and global counterparts

ADDITIONAL INFORMATION

  • Must be able to travel domestically up to 50% and internationally if needed;
  • Experience with project / vendor management
  • Strong platform skills:  including verbal and written communication and presentation abilities to multiple stakeholders at all levels of an organization;
  • Demonstrated ability to provide simple, translational information on complex issues such as Reimbursement, Government Issues and Public Policy
  • Demonstrated ability to lead without authority, influencing others despite level or role
  • Demonstrated understanding of organizational behaviour, corporate culture and to be able to flourish in a complex and rapidly evolving workplace;
  • Comprehensive understanding of the medical device industry in the acute and post-acute settings in both SUR and WC product solution area

 

To Apply: 

To Apply:

Contact Tony Harper directly at tony.harper@molnlycke.com or apply online by clicking the following link:  Director, Reimbursement & Government Affairs