Patient Access and Reimbursement Manager

Life Unlimited. At Smith+Nephew we design and manufacture technology that takes the limits off living. 

In this role, you will support the Wound Reimbursement department to achieve its mission to connect patients, providers, and payors and ensure patients can access best-in-class technologies and products (Grafix, Oasis, and PICO).  You will serve as the primary reimbursement expert supporting the field in all areas related to reimbursement of Company products and assist the Director or Sr. Director on execution of company strategies related to field reimbursement initiatives, including patient and HCP on-boarding and education, compliance, resources and communication.  You will work independently, develop strong relationships with each account, and develop strategies for prioritizing work and executing educational and supporting roles in a rapidly changing market.  You will work to ensure Company products are properly reimbursed and patient reimbursement related issues are resolved in a timely manner, always exemplifying professionalism, a great attitude, conflict resolution tactics, and exceptional customer service skills.

What will you be doing?

• Serve as the primary contact for reimbursement support and educate new and existing customers on billing, coding, how to submit claim forms, national and local coverage policies, and good clinical documentation.

• Act as the key liaison between the Reimbursement Hotline, providers, and Sales for monitoring and addressing issues related to insurance verification requests (IVR) using cloud-based workflow solutions.

• Educate providers and staff on payer policies, coverage criteria, claims issues, den2als, and appeals related to S+N products.

• Develop, utilize, and improve internal systems, processes, and tools for improving patient access in collaboration with Sales, Hotline, and Market Access colleagues.

• Monitor regional policy changes and work closely with the Market Access and the Hotline to ensure company has the latest coding information, coverage policies, claims outcomes, and treatment guidelines

What will you need to be successful?

• Bachelor’s Degree in the business, health sciences, management, healthcare administration or related field

• Advanced degree (MBA, MS, etc.) preferred

• Licenses/ Certifications:  Certified Professional Coder is a plus

• 8+ years of experience in biotechnology, pharmaceutical, medical device, or medical/hospital management industry

• 3+ years of experience in reimbursement, billing and coding within the healthcare, biotechnology, pharmaceutical, wound care or surgical device fields

• Comprehensive knowledge of healthcare reimbursement practices, billing procedures, compliance, coding, and medical terminology

• Strong background in sales, management, or reimbursement for “buy and bill” products in the biotechnology industry related to biologics, wound care and/or surgical procedures preferred

• Experience in wound care ICD-10 codes, coding, and billing preferred

• Travel Requirements:  Up to 65% 

You Unlimited.

We believe in creating the greatest good for society. Our strongest investments are in our people and the patients we serve.    

• Inclusion, Diversity and Equity: Committed to Welcoming, Celebrating and Thriving on Diversity, Learn more about Employee Inclusion Groups on our website (https://www.smith-nephew.com/) 

• Your Future: 401k Matching Program, 401k Plus Program, Discounted Stock Options, Tuition Reimbursement  

• Work/Life Balance: Flexible Personal/Vacation Time Off, Paid Holidays, Flex Holidays, Paid Community Service Day  

• Your Wellbeing: Medical, Dental, Vision, Health Savings Account (Employer Contribution of $500+ annually), Employee Assistance Program, Parental Leave, Fertility and Adoption Assistance Program 

• Flexibility: Hybrid Work Model (For most professional roles)  

• Training: Hands-On, Team-Customized, Mentorship  

• Extra Perks: Discounts on fitness clubs, travel and more!  

The anticipated base compensation range for this position is $90,000 - $140,000 USD annually. The actual base pay offered to the successful candidate will be based on multiple factors, including but not limited to job-related knowledge/skills, experience, geographical location, and internal equity. It is not typical for an individual to be hired at the high end of the range for their role at Smith + Nephew. Compensation decisions are dependent upon the facts and circumstances of each position and candidate. In addition to base pay, w