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Hours Full-time, Part-time
Location San Antonio, TX
San Antonio, Texas

About this job

Position Summary

Title: Senior Reimbursement Specialist at Global Integrated Reimbursement Services, Inc., must have experience with insurers, payer relations, managed care contracting, coding applications, Landscape Assessment, report writing, management of small teams, and client communications.

Location: USA-Cordova, TN / San Antonia, TX

Global Integrated Reimbursement Services Inc. provides solutions for Medical Technology Manufacturers that includes Payer Advocacy, innovative managed care contracting services, reimbursement consulting strategies by conducting Landscape Assessment, payer relations work, and managed care contracting strategies for specific new technologies. Our company was founded in the Washington D.C. area and has offices in both Bethesda, MD and Cordova, TN. We would like to open an office in San Antonio, TX and so this new hire, if in San Antonio, will get an opportunity to open and run a new office for GIRS in this location. We would hire an appropriate expert who shares our core values: Productivity, Quality, Growth, Innovation in services; Team Focus, Timeliness; Accountability, Compliance, Humility, Integrity, Recognition, good Vertical Communications with supervisors. These core values have supported our excellence in business for over 14 years.

Job: The Senior Reimbursement Specialist works on behalf of the manufacturer client and Global Integrated Reimbursement Services Inc., to research and verify with insurers (Medicare, Medicaid, Workers Compensation, Commercial Payers) the coding, coverage, payment and managed care contracting requirements and develops strategies to assist with the market uptake of client technologies. Results are documented in reports and databases. This position is on a career track for a management position. The Senior Reimbursement Specialist will be competent to develop her own schedule and project plans as well as the schedule for a small team. Plans, coordinates, reviews and evaluates the results of team members work. responds to account questions on coding, insurance coverage, and payment for the medical technologies. The incumbent of this position assists with policy reviews and analysis and documents results in policy review tools to educate clients about the coverage for their Product by different payers.

This position will also assist with the conducting of Landscape Assessment to develop strategies for medical technologies, complete coding applications and submit them on behalf of clients, and develop billing guides, and payer dossiers.

The incumbent of this position will assist with Business Development by assisting to develop proposals for services and presenting at proposal meetings by phone or in person. The coordination and management of the office is also a key function that involves opening and closing the office, ensuring all employees and contractors follow procedures to document their work and time for client reporting and payroll.

The incumbent of this position will have excellent vertical skills in communicating respectfully with the supervisor and the President and other senior team members and excellent horizontal communication skills in uniting team members to provide better access to patients to our client’s therapies. The incumbent of this position will also assist the President to grow the business units to ensure longevity and stability of jobs and future growth.

Essential Job Functions

Primary Duties and Responsibilities

1. Contact and liaison for manufacturer clients and GIRS.

2. Develop and maintain a thorough understanding of the dynamics driving the various managed markets segments and channels including Commercial Managed Care, Medicare, Medicaid, Exchanges, Trade, and Integrated Delivery Systems/Systems of Care, Accountable Care Organizations, Group Practices and Institutions.

3. Participate in Managed Care Contracting, Landscape Assessments, and other reimbursement projects.

4. Assists with the development of innovative contracting arrangements and strategies, pricing strategies, step therapy protocols, clinical guidelines, professional society and other stakeholder support.

5. Communicates with insurers on behalf of clients to advocate for positive coverage, to present and establish the value of client technologies to ensure appropriate payment and market uptake.

6. Responsible for assisting with the developing and implementing of standard operating procedures and other materials for the payer relations programs.

7. Support the training and coaching of staff based on SOPs

8. Develops daily work schedule, weekly schedules, and coordinates all daily activities with President/Supervisor to ensure program and team targets and goals are met.

9. Updates database and sends news flashes to clients on new coverage and payment developments.

10. Runs month end reports.

11. Monitors the performance of team members to ensure compliance with operating procedures and standard practices. Provides input to the President for evaluation of staff.

12. Assists President/supervisor with the selection of assigned personnel for projects.

13. Operates as an office expert in one or several health care or business-related areas.

14. Contributes input into areas of improving processes and procedures.

15. Provides clients and senior management team with updates relating to reimbursement trends and / or healthcare business related areas by writing blurbs for social media and email blasts.

16. Content development for Social Media.

Secondary Functions

1. Development of company newsletter.

2. Involved in the professional development of reimbursement department associates

3. Participate in consulting projects as appropriate.

4. Business development for call center work and payer relations. Participates in proposal efforts to ensure proposals meets client needs and specifications and to present with President to potential clients. Follow up with leads to educate potential clients about benefits of services and to propose medical technology hotline services and other reimbursement support services for identified potential clients. Incentive will be provided over base salary.

Qualifications:

Education

MBA with specialization in Health Care Policy or Masters in Health Services Administration. Ideally, MBA or MHSA with specialization in Marketing or a within a relevant discipline (health economics, health policy)

Qualification and Experience:

• A skilled consultant with experience in client engagement leader, able to build enduring client relationships and expand company presence in key accounts, and drive repeat business.

•Experienced (5+ years) in business development for reimbursement / market access consulting firm.

Experienced (5+ years) and strategy consultant in Payer/PBM landscape and competitive intelligence & analysis.

•Expertise in managed markets, payer and provider reimbursements, pricing and market access strategy for the biopharmaceutical industry.

•A flexible team player and who works confidently and persuasively in a multicultural environment

•Effective leader able to manage individuals and teams in addition to working well collaboratively with peers both within and across business units.

•Focused track record in the pharmaceutical industry, biologics, medical devices, with strong insight into the commercial planning and pricing, reimbursement and access processes.

Consulting Skills:

•Demonstrate a logical, rigorous, and analytical problem-solving approach, conducting primary and secondary research, leading requirements gathering sessions and preparing and delivering client presentations and work products

•Experience writing uses cases, user stories and acceptance criteria

•Experience with external facing applications planning and design

• Experience presenting, negotiating and selling to decision makers. Communicate business findings and strategic recommendations to senior management.

*Conduct and document complex business analysis

•Ability to adapt to change, work independently and in a team environment, organize work effectively and take initiative in fast-paced work environment while managing multiple tasks and deliverables simultaneously

•Skilled at analyzing complex issues and distilling concepts to clients

•Able to proactively identify risks, and drive action to mitigate and resolve issues

•Strong analytical and interpersonal communication skills, with the ability to work independently

•Strong organizational skills and the ability to manage a vast array of information

•Broad understanding of the role of data management, information flow, and data governance issues

•Able to serve as a liaison between both business and technical teams to drive effective, timely solutions that fulfill both strategic and operational needs

•Skilled at defining and documenting business processes and requirements for ongoing system enhancement initiatives

•Firm sense of accountability, ownership for end-to-end project lifecycle

•Excellent verbal, written and presentation skills, with the ability to interact efficiently with technical and non-technical groups

Knowledge of pharmaceutical industry.

Knowledge base in billing and reimbursement in the pharmaceutical/ medical technology industry.

Strong communication skills

Personal computer and business solutions software skills

Ability to manage large or multiple projects, handle multiple tasks simultaneously, and to switch between tasks quickly

Ability to deal with ambiguity and change Ability to work in a team environment

Ability to create and maintain formal and informal networks

Excellent writing skills and good working knowledge of computers in order to operate

Job Category: Consulting/Client Services/Payer Relations/Managed Care Contracting

Primary Location: United States; Memphis; San Antonio, TX

Competitive Salary, Benefits and Incentives:

Relocation Assistance