Director of Healthcare Economics and Reimbursement
The Director of Healthcare Economics and Reimbursement is responsible for providing leadership in the development, planning and execution of strategic reimbursement for CSI’s technologies. The activities are focused on the development and implementation of Health Economics and Reimbursement lifecycle strategies and tactics for marketed products, pipeline products/clinical studies and products evaluated in business development diligence endeavors and acquisitions. This position will play a key role in training and supporting the CSI commercialization team.
This role will lead the charge in the developing and disseminating tools while leveraging best practices sharing in regards to health economics and modeling, systematic literature reviews, global value dossier development and clinical and economic evidence generation targeted for publication.
This leadership position is accountable to provide early input into product value proposition development including analysis of strategic plans that reflect the payer and stakeholder needs. Additionally, the role will require the development and execution of health policy that shapes the reimbursement pathway for CSI’s technologies such as bundled payments, MIPS, ACOs, etc.
This position carries strategic responsibility as well as being the primary driver for tactical implementation. A successful candidate must demonstrate excellent communication and collaboration skills, a strategic, innovative mindset, and high level of competence in reimbursement and health economics for medical devices.
Essential Duties and Responsibilities:
- Partner with cross-functional teams throughout product life cycles (product charter/program management, clinical studies and commercialization) to develop and execute Health Economic and Reimbursement strategies and tactics that ensure CSI products have strong value propositions to meet customer needs of a dynamic reimbursement environment.
- Must possess a detailed understanding of clinical and economic evidence to support product positioning. Support the development of detailed dossiers covering the product, the comparators, market characteristics, clinical and economic evidence to support reimbursement and health technology assessment submissions. Development of economic tools such as Budget Impact Models.
- Direct analysis of policy issues affecting CSI’s business: developing sector position, data analysis, and advocacy including comments letters designed to influence policy.
- Communicate global evidence requirements and reimbursement landscape updates to the Commercial teams and Peripheral/Coronary Franchise Teams. Provides leadership support and direction for the evidence solutions to meet current and future business needs.
- Responsible for the development of external publications, as it relates to reimbursement and strategy. Ensure appropriate exposure of information is communicated to internal and external audiences in collaboration with Scientific Affairs.
- Responsible for all Medicare and Private Payer coverage, coding and payment strategies and participating in direct meetings with CMS.
- Monitor, analyze, and influence health care policy to ensure policy environment supports medical innovation (HTA, ICD-10, Value-Based Bundled Payments).
- Assess and communicate the coding, coverage and payment landscape, globally. Develop and execute specific strategies to enable optimal reimbursement in target regions and maintain agility to extend reach to emerging markets as portfolios expand to capitalize on global growth opportunities.
- Responsible for objective setting and quarterly business review updates specific to economic and reimbursement deliverables.
- Provide training and education programs on reimbursement best practices and health policy issues to internal personnel and may provide training and education to sales force, health care providers and hospital administrators.
- Develops sustainable strategic relationships with professional societies, medical associations, advocacy groups, thought leaders and trade groups to provide leadership and focus in areas of mutual interest such as physician reimbursement, treatment guidelines, coverage and payment for products/therapies, etc.
- Working with cross-functional teams, lead the development or improvement of tools utilized by the commercial organization to effectively communicate relevant Healthcare Policy (reimbursement, healthcare economics and policy) information and messaging related to CSI products.
- Maintain a current knowledge of the reimbursement landscape within the interventional coronary and peripheral vascular disease markets. Monitor changes in the external environment (regulatory/reimbursement changes, managed care arrangements, HTA’s, clinical guidelines, etc.) and advise senior management on threats and opportunities with suggested action plans.
- Maintain/update CSI reimbursement coding guides on CSI360.com and develop a regular cadence of Health Policy Updates for CSI internal team members and external CSI stakeholders, respectively.
- Manage consultants including reimbursement hotline
Knowledge, Skills and Abilities Required for Successful Job Performance:
- BS/BA in a relevant field (advanced degree preferred) and proven track record in reimbursement, healthcare economics/policy in medical device, pharmaceutical, biotechnology or hospital setting.
- Strong, Director level experience in the medical device or similar field, working directly with Health Care Policy
- A minimum of 8 years of successful work experience in the medical device or related field with focus on reimbursement, healthcare economics and/or healthcare policy (preferably some experience in all three areas but most importantly will have experience with U.S. reimbursement).
- Must have proven expertise in reimbursement coding, billing processes and claim submissions to public and private insurers.
- Must have strong project management skills and experience.
- Must have polished communication skills including written documentation and oral presentations.
- International experience is strongly preferred.
- Ability to read, analyze, and interpret common scientific and technical journals, financial reports, and legal documents. Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community.
- This position will interact routinely with internal and external stakeholders including sales representatives/management, marketing, regulatory, clinical, science, and finance teams and external stakeholders including hospital administrators and physicians, CMS and other payers, physician societies and other Healthcare Policy stakeholders.
- Ability to define problems, collect data, establish facts, and draw valid conclusions.
- Ensure compliance with HE&R related activities
CSI is an EEO/AA company: Women, Minorities, the Disabled and Veterans are encouraged to apply. If you are a job seeker with a disability and require accessibility assistance or reasonable accommodation to apply for an open position, please contact the Recruiting Department at Cardiovascular Systems, Inc., 1225 Old Hwy 8, New Brighton MN 55112, or call (651) 259-1600.