Area Reimbursement Manager
Area Reimbursement Manager
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1 Vacancy
Job Description
SIBONE is a fastgrowing publicly traded medical device company that is an industry pioneer in minimally invasive sacropelvic solutions. Our mission is to help patients rise up and reach for the stars and our vision is to work together as the global leader to make sacropelvic conditions universally recognized and effectively treated through innovation evidence education and advocacy.
Area Reimbursement Manager
SIBONE is focused on helping patients in one of the most underserved underdiagnosed and undertreated areas in orthopedics the sacroiliac (SI) joint. SIBONE developed an innovative patented implant to fuse the SI joint. The iFuse Implant System provides a less invasive alternative to traditional sacroiliac (SI) joint fusion surgery and has been used in over 90000 procedures to date.
We are a medical device company that is focused on improving the lives of patients with sacroiliac pelvic conditions. We are looking for people who are passionate about our mission and who are willing to work hard to achieve it. We are also looking for people who are:
Agile: We work in a fastpaced environment and need to be able to learn and adapt to change quickly.
Creative: We embrace creativity and we need people who are not afraid to challenge the status quo.
Team Players: We rollup our sleeves and work together as one team to achieve our goals.
General Responsibilities:
- Reports to Area Reimbursement Director
- Acts as the internal expert and resource on coding and reimbursement for SIBONES product portfolio
- Provide effective collaboration between the reimbursement team sales organization and physicians/surgeons offices to develop case reimbursement strategies in attempts to secure coverage for iFuse system implantation
- Build collaborative relationships with Territory and Regional sales representatives to prioritize and optimize reimbursement support services in the region
- Interface and collaborate with governmental reimbursement entities (Medicare Medicaid TRICARE etc. and commercial payors in assigned region
- Collaborate with marketing clinical regulatory and sales teams concerning ongoing operations needs
- The Area Reimbursement Manager must act and conduct company business in an honest ethical and lawful manner consistent with the companys Code of Conduct other company policies and the AdvaMed Code of Conduct and/or any other applicable industry code(s) of conduct. The company does not tolerate retaliation in connection with making good faith reports of suspected violations.
- Responsible for performing all duties in compliance with all applicable worldwide regulatory requirements as included in the scope of the SIBONE Quality Manual
Specific Responsibilities and Skills:
- Execute case management appeal activities to ensure optimal opportunity for successful overturn of denied iFuse claims by providers to support education on medical necessity either physician/surgeon and/or facility i.e. inpatient outpatient officebased lab and ambulatory surgery center
- Provide subject matter expertise regarding payors and coverage
- Execute payor relations activities to yield favorable coverage decisions
- Proactively seek out payor presentation opportunities
- Participate in development of reimbursement presentation and training materials relative to physician users and payor decisionmakers with relevant internal stakeholders
- Execute coding strategy for all sites of care
- Visit surgeons offices in person or virtually to provide overview of Patient Insurance Case Support program and resource offerings
- Represent the company at medical conferences physician payor tradeshows and company meetings as SI Bones reimbursement expert as appropriate
- Collaborate and communicate regularly with reimbursement team and sales teams
- Delivers clear messages that are disseminated to SIBONE leadership regarding payor trends reimbursement changes and billing & documentation requirements relating to SIBONE products
- Support the SIBONE Quality System
- Other duties as assigned
Knowledge Education and Experience:
- Bachelors degree or equivalent experience
- Minimum of 5 years of experience in reimbursement activities with a medical device or pharma company
- Significant experience in creating market access with commercial payors;
- Direct experience with Medicare Transitional PassThrough (TPT) and New Technology AddOn Payment (NTAP) preferred
- Previous coding and billing experience in an office hospital ASC setting preferred
- Experience in Medical Device Industry preferred
Expertise and Attributes:
- A strong understanding of medical device reimbursement coding coverage and payment processes and practices
- Available to travel as needed
- Customer focused individual
- Thorough knowledge of reimbursement
- Demonstrated success in handling a reimbursement region with another medical device company
- Experience in development of medical coverage policies and gaining favorable coverage decisions with government and commercial payors
- High level of interpersonal skills: influencing resolving conflict and creative problem solving. Must be an excellent communicator using all available channels
- Ability to make effective presentations to cross functional areas of the company and to outside healthcare professionals and payors
- A history of successfully managing relationships at all levels of the organization
- Strong organizational skills ability to prioritize and complete projects
- Effective analytical and problemsolving skills with the ability to handle multiple projects and apply creative solutions to challenges
- Possess a high level of energy and collaborative management style
- Demonstrated proficiency with Word Excel PowerPoint and Salesforce
- Ability to work in a fastpaced thinly resourced organization
- Knowledge and familiarity of applicable regulations/standards (e.g. ISO 13485 FDA 21 CFR 820 EU MDR 2017/745 ISO 14971 as required to perform the job function
Salary range: $125000 $135000. The compensation range for this position is specific to the location and is in good faith what SIBONE expects to pay for the position taking into account the wide variety of factors that are considered in making compensation decisions including jobrelated knowledge; skillset; experience education and training; certifications; and other relevant business and organizational factors.
Supplemental pay: bonus and stock
There are potential risks associated with the iFuse Implant System. It may not be appropriate for all patients and all patients may not benefit. For additional information on the company or the products including risks and benefits please visit are aware of active recruitment scams using the SIBONE name in which individuals pose as our recruiters and post fake remote job openings and make fake job offers on the Internet. Please note we will never make an offer of employment without conducting multiple rounds of interviews facetoface using secure videoconferencing technology. We will never ask candidates to cash checks or make a payment in order to be considered for a position. SIBONE only uses company email addresses which contain @sibone to communicate with candidates.
If you believe youve been a victim of a phishing scam please visit the Cybersecurity & Infrastructure Security Agency at learn how to report it.
Required Experience:
Manager
Employment Type
Full Time
