Senior Payer Policy and Relations Analyst - CRDN

We are looking for a  Senior Payer Policy and Relations Analyst to join our Health Economics, Policy, and Reimbursement (HEPR) team.  The primary objective of this role is to support the development and execution of U.S. Coverage and reimbursement strategy through engagement with U.S. payer organizations. The individual acts as a business support to the cross-functional leaders and staff within the HEPR organization. 

This role offers the opportunity to support the establishment of reimbursement of innovative new therapies in the following Medtronic OUs: Coronary & Renal Denervation (CRDN), Peripheral Vascular Health (PVH), Cardiac Surgery (CS), and Structural Heart & Aortic (SH &A).  Renal denervation is an example one of the key therapies this position will support.  Renal denervation is an innovative procedure that helps lower a patient’s blood pressure. The technique targets specific nerves near the kidneys that can become overactive and cause high blood pressure, also known as hypertension. High blood pressure is a global epidemic, affecting one-third of adults. The role is a unique opportunity to help establish reimbursement for a new-to-world medical device that will potentially transform healthcare globally. 

• Develops and manages a network key contacts and relationships with policy makers for U.S. Commercial insurers, Medicaid Payers, and local Medicare Contractors; 

• Develop tools to accelerate positive U.S. payer coverage particularly among commercial payers. This includes but is not limited to the development of model coverage policies, value dossiers, coverage request submissions, and documents to help providers navigate the prior authorization and claim denial process; 

• Assists in the analysis and reporting on government and commercial payer policies affecting reimbursement and/or patient access and develops recommendations to address resulting opportunities or challenges; 

• Interacts with local physician champions and important stakeholder groups to facilitate effective engagement with payers; 

• Partner with Field-focused organizations for coordination with payer strategy; 

• Work with Government Affairs to drive coverage and payment among state Medicaid plans; 

• Collaborate with legal, compliance, and other business groups to assure appropriate engagement processes are strictly adhered; 

• Support and develop internal communications around coverage policy changes. 

• To be successful, this role will develop a deep understanding of company products and therapies, health and payment policies and structures, and the types of evidence that are appropriate for supporting business priorities. 

Responsibilities

• Facilitate patient access to CRDN, PVH, CS, and SH&A therapies by collaborating with cross-functional teams on reimbursement submissions and development of reimbursement tools & materials to enable successful product launches 

• Develop resources and support physician & customer training and education on reimbursement 

• Review, assess, and execute payer strategies for establishing, continuing, and expanding therapy coverage 

• Participate in discussion of health claim analyses and economic data for tool creation, market intelligence, and evidence strategy 

• Maintain expertise in U.S. payer procedures (including prior authorization and appeals) and reports as well as coding, coverage, and payment. 

• Expected travel: approximately 10-15%. Position can be based remotely with occasional travel for team meetings, meeting with colleagues, and external conferences. 

Must Have: Minimum Requirements 

• Bachelor’s Degree 

• 4 years healthcare payer experience with US payer organizations 

• Or 2 years healthcare payer experience with US payer organizations and an advanced degree 

Nice to Have 

• Minimum 5 years healthcare payer experience with US payer organizations 
   

• Master’s degree (MBA or MHA preferred) or advanced degree in health policy, health services research, economics, biostatistics, epidemiology, public administration, clinical research or a related discipline 

• Experience working in medical device industry or hospital administration 

• Significant experience with development of clinical policies for medical benefits at U.S. commercial payers 

• Knowledgeable in hospital-based medical device reimbursement, including U.S. healthcare coding (HCPCS/CPT and ICD-10) and Medicare and U.S. commercial payers 

• Understanding of and experience with health economic methods, including cost-effectiveness and budget impact analyses 

• Highly effective verbal and written communication skills 

• Skilled and engaging presenter, including executive-level audiences 

• Strong project management skills, results orientation, quality orientation, proactive, with attention to detail 

• Ability to work comfortably and collaboratively across cultures in a complex, global matrix organization 

• Experienced with Microsoft Office suite of applications 

• Knowledgeable of cardiovascular therapies, particularly coronary, structural heart, and peripheral vascular 

• Knowledgeable of state Medicaid and integrated payer-provider reimbursement pathways 

• Demonstrated influence management skills and ability to work effectively in a matrixed organization