Area Reimbursement Manager

Area Reimbursement Manager

SI-BONE® is focused on helping patients in one of the most under-served, under-diagnosed, and under-treated areas in orthopedics, the sacroiliac (SI) joint. SI-BONE developed an innovative, patented implant to fuse the SI joint. The iFuse Implant System® provides a less invasive alternative to traditional sacroiliac (SI) joint fusion surgery and has been used in over 90,000 procedures to date. 

We are a medical device company that is focused on improving the lives of patients with sacroiliac pelvic conditions. We are looking for people who are passionate about our mission and who are willing to work hard to achieve it. We are also looking for people who are: 

• Agile: We work in a fast-paced environment and need to be able to learn and adapt to change quickly. 

• Creative: We embrace creativity, and we need people who are not afraid to challenge the status quo. 

• Team Players: We roll-up our sleeves and work together as one team to achieve our goals. 

General Responsibilities:

• Reports to Area Reimbursement Director
• Acts as the internal expert and resource on coding and reimbursement for SI-BONES product portfolio  
• Provide effective collaboration between the reimbursement team, sales organization and physicians/surgeon’s offices to develop case reimbursement strategies in attempts to secure coverage for iFuse system implantation
• Build collaborative relationships with Territory and Regional sales representatives to prioritize and optimize reimbursement support services in the region
• Interface and collaborate with governmental reimbursement entities (Medicare, Medicaid, TRICARE, etc.) and commercial payors in assigned region
• Collaborate with marketing, clinical, regulatory, and sales teams concerning ongoing operation’s needs
• The Area Reimbursement Manager must act and conduct company business in an honest, ethical and lawful manner, consistent with the company’s Code of Conduct, other company policies and the AdvaMed Code of Conduct and/or any other applicable industry code(s) of conduct. The company does not tolerate retaliation in connection with making good faith reports of suspected violations.
• Responsible for performing all duties in compliance with all applicable worldwide regulatory requirements as included in the scope of the SI-BONE Quality Manual

Specific Responsibilities and Skills:

• Execute case management appeal activities to ensure optimal opportunity for successful overturn of denied iFuse claims by providers to support education on medical necessity – either physician/surgeon and/or facility, i.e., inpatient, outpatient, office-based lab, and ambulatory surgery center
• Provide subject matter expertise regarding payors and coverage
• Execute payor relations activities to yield favorable coverage decisions
• Proactively seek out payor presentation opportunities
• Participate in development of reimbursement presentation and training materials relative to physician users and payor decision-makers with relevant internal stakeholders
• Execute coding strategy for all sites of care
• Visit surgeon’s offices in person or virtually to provide overview of Patient Insurance Case Support program and resource offerings,
• Represent the company at medical conferences, physician, payor, tradeshows and company meetings as SI Bone’s reimbursement expert, as appropriate
• Collaborate and communicate regularly with reimbursement team and sales teams
• Delivers clear messages that are disseminated to SI-BONE leadership regarding payor trends, reimbursement changes, and billing & documentation requirements relating to SI-BONE products
• Support the SI-BONE Quality System
• Other duties as assigned

Knowledge, Education and Experience:

• Bachelor’s degree or equivalent experience
• Minimum of 5 years of experience in reimbursement activities with a medical device or pharma company
• Significant experience in creating market access with commercial payors;
• Direct experience with Medicare Transitional Pass-Through (TPT) and New Technology Add-On Payment (NTAP) preferred
• Previous coding and billing experience in an office, hospital, ASC setting preferred
• Experience in Medical Device Industry preferred

Expertise and Attributes:

• A strong understanding of medical device reimbursement coding, coverage and payment processes and practices
• Available to travel as needed
• Customer focused individual
• Thorough knowledge of reimbursement
• Demonstrated success in handling a reimbursement region with another medical device company
• Experience in development of medical coverage policies and gaining favorable coverage decisions with government and commercial payors
• High level of interpersonal skills: influencing, resolving conflict, and creative problem solving. Must be an excellent communicator using all available channels
• Ability to make effective presentations to cross functional areas of the company, and to outside healthcare professionals and payors
• A history of successfully managing relationships at all levels of the organization
• Strong organizational skills, ability to prioritize and complete projects
• Effective analytical and problem-solving skills with the ability to handle multiple projects and apply creative solutions to challenges
• Possess a high level of energy and collaborative management style
• Demonstrated proficiency with Word, Excel, PowerPoint and Salesforce.com
• Ability to work in a fast-paced, thinly resourced organization
• Knowledge and familiarity of applicable regulations/standards (e.g. ISO 13485, FDA 21 CFR 820, EU MDR 2017/745, ISO 14971) as required to perform the job function

Salary range:  $125,000- $135,000. The compensation range for this position is specific to the location and is in good faith what SI-BONE expects to pay for the position taking into account the wide variety of factors that are considered in making compensation decisions, including job-related knowledge; skillset; experience, education and training; certifications; and other relevant business and organizational factors.

Supplemental pay: bonus and stock