Area Reimbursement Manager

The Area Reimbursement Manager at SI-BONE is responsible for developing and implementing reimbursement strategies for the iFuse Implant System. This includes acting as the internal expert on coding and reimbursement, collaborating with sales representatives, managing relationships with payors, and providing education on medical necessity to support claim appeals. Additionally, the position requires close collaboration with various departments, including marketing, clinical, and regulatory teams.

To be considered for the Area Reimbursement Manager position at SI-BONE, candidates should hold a bachelor’s degree or equivalent experience, along with a minimum of 5 years in reimbursement activities, preferably in the medical device or pharmaceutical sectors. Relevant experience with Medicare and commercial payors, along with coding and billing expertise, is advantageous. Strong communication, analytical skills, and a collaborative spirit are essential attributes for success in this role.

The Area Reimbursement Manager at SI-BONE interacts with governmental and commercial payors to negotiate coverage terms and develop favorable reimbursement strategies for the iFuse Implant System. This includes executing payor relations activities, seeking opportunities for presentations, and staying informed about evolving payor trends. Building collaborative relationships is key to ensuring the success of reimbursement initiatives.

Candidates with direct experience in medical device reimbursement coding, as well as a proven track record of developing medical coverage policies, will stand out for the Area Reimbursement Manager role at SI-BONE. Experience in managing relationships with various stakeholders, including healthcare professionals and payors, is vital. Familiarity with regulations guiding reimbursement practices is also beneficial.

The salary range for the Area Reimbursement Manager position at SI-BONE is between $125,000 and $135,000. This range reflects the company’s commitment to fairly compensating employees based on their job-related knowledge, skills, experiences, and qualifications while considering industry standards.

In your answer, detail your specific experiences working with coding systems, how you navigated reimbursement challenges, and your familiarity with payer policies and regulations. Highlight any successful strategies you've implemented to improve reimbursement outcomes.

Discuss your methodology in assessing market access challenges and opportunities, analyzing payer requirements, and collaborating with cross-functional teams to determine the best approach for launching a product successfully. Emphasize your ability to adapt strategies based on real-time feedback and engagement with healthcare professionals.

Describe your strategies for building and maintaining relationships, including communication techniques, frequency of interactions, and how you handle challenges or conflicts. Illustrate with examples of how these relationships have led to favorable outcomes in your previous roles.

Explain your step-by-step process for analyzing denied claims, determining the root causes for denial, and your approach to developing appeals. Share any successful case studies where your efforts resulted in overturned claims and reimbursement recovery.

Talk about how you prioritize collaboration, especially with teams like sales, marketing, and clinical affairs. Provide examples of how collaborative efforts have improved outcomes for reimbursement processes or patient access to products.

Share a relevant challenge, detailing your analysis, the steps you took to address it, and the ultimate resolution. Focus on your problem-solving skills and resilience in navigating complex reimbursement environments.

Discuss the resources, networks, and tools you use to keep informed about new regulations, payer policy updates, and industry trends. Highlight any professional organizations or groups that you belong to, and how this knowledge has impacted your work.

Outline how you develop training materials and programs, focusing on making complex concepts accessible and actionable for sales staff. Share examples of training outcomes that enhanced team performance in discussing reimbursement with clients.

Provide a specific example where your engagement or persuasive techniques made a difference in a coverage decision. Highlight your analytical skills, communication abilities, and your understanding of payer dynamics in your explanation.

Discuss the combination of soft and hard skills that contribute to success in this role, including analytical thinking, communication, negotiation, relationship management, and understanding of regulations. Provide examples of how these skills have played a pivotal role in your career.