Manager, Payer Relations
Zimmer (Fort Wayne, Indiana)

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Job Summary

The Manager of Payer Relations reports directly to the Senior Manager, Reimbursement and Health Policy. The primary responsibility of this position will be to work with private/commercial, worker’s compensation, government (Medicare and Medicaid) and self-insured/funded payers to obtain and maintain appropriate reimbursement (coverage, coding and payment) for new and existing Zimmer technologies.

General Functions

· Work directly with public and private payers and other external stakeholders as necessary to drive Zimmer reimbursement strategies for new and existing Zimmer technologies;

· Communicate reimbursement strategies to the field sales organization and customers;

· Provide strategic planning and analysis on a payer-by-payer basis;

· Work with and develop relationships with regional medical technology and payer industry associations and societies;

· Monitor public and private payer policies for Zimmer technologies;

· Identify and develop local reimbursement advocates, especially key opinion leaders in the physician community;

· Develop and implement private payer outreach strategies in support of key products;

· Establish working relationships with related professional organizations, trade party associations and other key third parties to influence outcomes of critical policy issues;

· Manage consultants and other outsourced resources involved in key health economics and reimbursement projects to optimize outcomes and maximize ROI.

This is not an exhaustive list of duties or functions and may not necessarily comprise all of the "essential functions" for purposes of the ADA

Expected Areas of Competence (i.e., KSAs)

· Experience in healthcare arena, with emphasis on medical device reimbursement, payer relations, workers compensation and/or managed care;

· Solid understanding of key public and private payer policy infrastructure, payment methodologies, coding and coverage, health policy trends and current business challenges;

· Strong business acumen, analytical skills and experience working with various internal business partners (especially Sales, Marketing, Clinical, Regulatory, Legal, and Government Affairs staff) to provide insight into key reimbursement and economic issues for key products;

· Ability to balance strategic thinking with intricate planning and strong tactical execution;

· Expert knowledge of U.S. reimbursement and health insurance programs;

· Solid understanding of the overall business environment, the orthopaedic industry, and the marketplace

Educational Requirements

MBA with 3-5 years experience in medical device reimbursement, managed care, government/state affairs and/or related health care industry.

Skill Requirements

Must have prior experience in U.S. healthcare business, preferably medical devices. Excellent working knowledge of U.S. payers and related reimbursement systems. Experience with development and implementation of reimbursement strategies would be a plus. Demonstrated ability to operate effectively in a matrix business environment. Strong analytical, oral and written communication skills required.

Travel Requirements – 45-55%

Requirements:

Areas of Interest Health Economics

Expertise Health Economics; Reimbursement; Knowledge of Healthcare Environment, Medicare, Major Private Payers; Health Policy

Education College

Job Type Full Time

Locale Minnesota-Minneapolis or Indiana-Warsaw

Job Experience 5 – 10 years

Percent Travel 45-55%

Preferred Language English

Education: Masters Job Level: 8 - 10 years Percent Travel: 21-30%