Health Policy Manager Jobs in Decatur, GA (NOW HIRING)

At MIMEDX, our purpose starts with helping humans heal. We are driven by discovering and developing regenerative biologics utilizing human placental tissue to provide breakthrough therapies addressing the unmet medical needs for patients across multiple areas of healthcare. Possessing a strong portfolio of industry leading advanced wound care & surgical products combined with a promising clinical pipeline, we are committed to making a transformative impact on the lives of patients we serve globally.

We are excited to add a Director, Health Policy to our Health Policy team! The position will pay between $195,000 - $235,000 plus annual bonus and equity based on previous relevant experience, educational credentials, and location.  This is a remote position with up to 15% travel.

POSITION SUMMARY:

Support the implementation and prioritization of proactive legislative and regulatory rulemaking initiatives that support key business objectives and drive business development opportunities.  Play a key role in effecting favorable coverage decisions from all payers, with focus on Medicare, Medicaid and commercial payers.  Formulate and execute strategies to maximize payer approval for existing and new products including but not limited to clinical and health economic data generation.  Manage all health policy communications and relationships with all payers as well as other key stakeholders.  Provide ongoing payer research to identify changes or updates in coverage of company products. 

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Create and implement strategies that influence a positive coverage decision for company products from payers; establish health policy coverage and awareness through negotiations with medical directors and/or medical policy committees
• Identify and monitor changes in medical policy, trends in the US Healthcare system, and regulations that impact providers; seek legal guidance and/or team input as applicable
• Participate in market access expansion efforts in the U.S. and global markets by completing product coverage requests, and submitting medical summaries and assessments to payers for review
• Communicate with payer contacts to clarify coverage and reimbursement issues
• Direct the education of the team members in product coding and medical coverage decisions of all payers and provide guidance on how to communicate new or existing information to affected departments
• Communicate with key medical providers and sales team to proactively plan, implement, and strategize on market expansion of our products
• Provide guidance to junior team members on prioritizing payer coverage policy initiatives; , define annual performance goals, conduct annual reviews and one-on-one team member meetings
• Prepare assigned territory business plans, monthly activity reports, and other reports as requested

EDUCATION/EXPERIENCE:

• BS/BA in related discipline
• 8+ years of experience in a directly related field including several years in a management/supervisory capacity, or verifiable ability. Certification is required in some areas
• Prefer professional billing and coding experience and/or certification
• Experience with pharmaceutical, biotechnology and/or device health policy and reimbursement
• Demonstrated knowledge in securing coverage, coding and payment for medical products with government and commercial payers

SKILLS/COMPETENCIES:

• Excellent oral, written, and interpersonal communication skills
• Ability to interact with all levels of management, both internal and external, third party payers, and customers

• Ability to lead and inspire a team to meet organizational deliverables

• Proficient in Microsoft Office (Excel, Word, etc.)
• Organized, flexible, and able to multi-task while maintaining a high level of efficiency and attention to detail
• Strong analytical and negotiating skills, clinical interests, strategic and technical analysis and problem solving skills
• Ability to influence others to achieve desired results using tenacity and diplomacy
• Strong research and presentation skills