Director of Patient Access & Healthcare Economics

The Director of Patient Access & Healthcare Economics will be a key member of the commercial team and will be responsible for a broad range of initiatives to develop and grow a new opportunity in the orthopedics space.

Director of Patient Access & Healthcare Economics

A: Purpose and Scope

 

The Director of Patient Access & Healthcare Economics will be a key member of the commercial team and will be responsible for a broad range of initiatives to develop and grow a new opportunity in the orthopedics space.

 

The Director will serve as the Company expert in payer policies, patient, and provider support to facilitate patient access to Moximed’s MISHA Knee System. The Director will work in collaboration with our contracted reimbursement partner to establish and follow a strategy that will build from case-by-case support to local, and ultimately national level coverage policy decisions.

 

This individual will act as liaison between our reimbursement partner and our commercial team, creating a high level of service, training, and communication, not only for our commercial team but our surgeon and hospital partners. An effective director will have a strong business acumen and a will to make it happen.

 

The Director of Patient Access & Healthcare Economics must be detail-oriented, comfortable juggling multiple changing priorities, committed to managing and influencing across multiple stakeholders, and driven to meet deadlines in a fast-paced and dynamic environment.

 

B: Responsibilities

 

  • Collaborates with reimbursement partner to identify and eliminate barriers for patients enrolled in myMisha
  • Identity and fill gaps between our reimbursement partner and our commercial teams
  • Reviews reimbursement partner reporting, identifying any issues or updates, and communicating such to the appropriate commercial team members in a timely manner
  • Works in tandem with Territory Managers to appropriately educate HCPs and other relevant stakeholderson the reimbursement program for the MISHA Knee System
  • Ensures that patient and HCP interaction with myMISHA is customer centric and provides a favorable user experience
  • Partners with Territory Managers to identify and win support from key decision makers to accelerate facility approval of the product
  • Works with Marketing team and Sales leadership to develop business case support for MISHA Knee System
  • Provides support to commercial to team in order to expedite Value Analysis Committee (VAC) approvals
  • Design and implement internal reimbursement training, reflective of the Company’s reimbursement program, for new and current employees
  • Collaborate with Marketing and reimbursement partners to development and maintain product-specific reimbursement materials
  • Oversight of the activities of our reimbursement partners
  • Identifies, monitors, and responds to signals from case-level reimbursement metrics to improve business performance
  • Monitors reimbursement trends (e.g., HCPs receiving notification of policy changes, claim denials, underpayments, etc.) and engage reimbursement partner as appropriate when patient access may be jeopardized
  • Maintains expertise in regional and national payer landscapes, specifically, proper clinical requirements, reimbursement policy, utilization management criteria, prior authorization processes and appeal requirements
  • Ensures compliance of reimbursement and patient access programs with all applicable laws and regulations
  • Work with Clinical and Regulatory Affairs to ensure reimbursement and outcome planning is reflected in overall development plans and timelines for current and future clinical studies
  • Contributes to long-term reimbursement strategy and ensures current and intermediate tactics support long-term objectives
  • Maintains relationships with key reimbursement stakeholders, e.g., orthopedic societies, CMS, policy makers, etc.Ability to travel to assist commercial teams, as well as attend scheduled training and meetings. Travel anticipated at <40%

 

 

 

 

 

 

 

 

C: Organizational Relationships

 

  • Reports directly to the Chief Business and Strategy Officer.

 

 

JOB REQUIREMENTS:

 

  1. Education, Training & Technical Requirements

 

  • Bachelor’s Degree in related field, MBA or RN preferred
  • 7+ years of experience working with medical devices in a patient access and healthcare economics related position
  • New product launch experience
  • Proven record of accomplishment in achieving objectives and corporate goals with minimal direct supervision and demonstrated creativity, situation analysis/problem solving skills and analytical skill ability.
  • Successful navigation of complex authorization processes for new disruptive technology
  • Educate HCPs and facility partners on the availability of the Company’s’ patient support programs (myMisha)
  • Previous sales, district management, field reimbursement, hospital or practice experience preferred
  • Track record of forming positive/successful relationships with external vendors
  • Comfortable working with surgeons, patients, policy makers
  • Excellent communication skills

 

  1. Managerial Experience
  • Significant experience working with, and oversight of, a patient service center/hub

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