Mom and Baby Senior Director Reimbursement & Innovation Strategy

Mom and Baby Senior Director Reimbursement & Innovation Strategy

Aeroflow Health is a leading provider of home medical equipment and clinical support services helping patients across the country access the products and care they need to live healthier lives at home. Through innovative technology streamlined delivery platforms and deep expertise in insurance navigation we remove barriers to care and simplify complex healthcare processes for families providers and payers alike.

Headquartered in Western North Carolina Aeroflow is proud to be one of the fastest-growing healthcare companies in the country recognized on the Inc. 5000 list and consistently certified as a Great Place to Work. As we continue to grow we remain committed to building an exceptional workplace where talented professionals are empowered supported and inspired to make meaningful impact every day.

The Opportunity

Aeroflow Health is seeking a strategic healthcare leader to drive the future of reimbursement strategy care model innovation and scalable clinical service design across the Mom & Baby division.

This role serves as the enterprise leader responsible for translating evolving payer policy reimbursement frameworks and regulatory requirements into scalable business opportunities sustainable care models and operational strategies that support Aeroflows long-term growth beyond DME.

The Senior Director will partner cross-functionally with executive leadership payer relations clinical operations product legal/compliance finance and business unit leaders to evaluate design and operationalize new maternal health and virtual care services that are financially viable operationally scalable clinically compliant and strategically differentiated in the market.

This leader will help shape Aeroflows expansion into integrated maternal health services including lactation nutrition telehealth care coordination education remote monitoring and emerging perinatal support models.

Examples of supported areas include:

• Lactation classes and clinical lactation services
• CHW care coordination programs
• Nutrition & perinatal education programs
• Doula and birth support services
• Telehealth medical visits and remote patient monitoring
• New clinical services added across Aeroflow business units

Your Primary Responsibilities

We are currently seeking a Senior Director Reimbursement & Innovation Strategy to:

• Serve as Aeroflows enterprise expert on federal state and commercial reimbursement rules across telehealth maternal health DME-adjacent services and emerging care models.
• Research and interpret coverage policies billing rules provider qualifications supervision requirements and documentation standards across commercial Medicare and Medicaid payers.
• Develop and maintain the foundational reimbursement infrastructure necessary to support scalable maternal health and virtual care service expansion including coding strategy documentation standards governance processes and operational playbooks.
• Build and evolve centralized reimbursement and coding strategies for classes clinical services virtual care care coordination and hybrid product service delivery models.
• Evaluate new service offerings for reimbursement viability including coding pathways provider credentialing needs operational scalability and payer-specific limitations.
• Maintain deep knowledge of CPT HCPCS ICD-10 and emerging codes relevant to maternal perinatal telehealth education and preventative care services.
• Ensure Aeroflow utilizes appropriate codes modifiers place-of-service designations and documentation standards necessary to support compliant billing and optimized reimbursement outcomes.
• Identify gaps inconsistencies or operational risks within billing and coding methodologies and recommend scalable corrective solutions.
• Assess provider types required for billable services (e.g. IBCLC MD NP PA PT CHW doula RD) and align care delivery models to payer-specific requirements and reimbursement opportunities.
• Partner closely with Payer Relations to align internal billing methodologies with payer contracts coverage policies and evolving reimbursement opportunities.
• Collaborate with Clinical Leadership to design compliant documentation standards workflows and care delivery processes that support sustainable reimbursement and exceptional patient care.
• Advise Product and Technology teams on workflow design coding logic documentation capture automation opportunities and scalable reimbursement-enabled platform capabilities.
• Partner with Compliance Legal and Operations teams to support audit readiness regulatory adherence and enterprise risk mitigation.
• Build reimbursement governance frameworks SOPs coverage matrices educational materials and operational playbooks that translate complex payer policy into clear organizational guidance.
• Serve as the enterprise escalation point for coding interpretation reimbursement strategy benefit review and payer policy questions across the organization.
• Monitor national reimbursement trends maternal health policy evolution Medicaid transformation initiatives and virtual care regulations to identify strategic opportunities and organizational risk.
• Advise executive leadership on reimbursement-driven business opportunities emerging care models operational scalability and long-term maternal health service expansion strategies.
• Support the design and operationalization of innovative maternal health programs including preventative care models longitudinal support services telehealth pathways and integrated clinical service offerings.
• Partner cross-functionally with executive leadership to evaluate the financial sustainability reimbursement feasibility and scalability of new healthcare services and strategic growth initiatives.
• Help shape Aeroflows long-term expansion beyond traditional DME services through reimbursement strategy care model innovation and operational enablement.
• Employee has an individual responsibility for knowledge of and compliance with laws regulations and policies.
• Compliance is a condition of employment and is considered an element of job performance.
• Maintain HIPAA/patient confidentiality.
• Regular and reliable attendance as assigned by your schedule.
• Other duties as assigned.

Skills for Success

• Possesses a comprehensive understanding of how payer regulations CMS guidelines state Medicaid transformation initiatives and evolving healthcare policies influence reimbursement strategy operational workflows and the design of scalable care delivery models.
• Demonstrates the ability to integrate reimbursement strategy operational execution financial sustainability and patient care delivery into cohesive enterprise-wide solutions.
• Maintains a strong command of coding frameworks across multi-state environments specifically for telehealth maternal health preventative care PT/OT CHW lactation nutrition and perinatal education services.
• Experienced in the evaluation and design of scalable healthcare delivery models across virtual hybrid preventative and service-based care environments.
• Aptitude for synthesizing complex reimbursement policies regulatory guidance and payer frameworks into actionable organizational recommendations and strategic business opportunities.
• Effectively guides and aligns diverse stakeholders across clinical operations payer relations compliance finance product technology and executive leadership teams.
• Skilled at translating regulatory complexity into practical processes workflows documentation standards governance structures and scalable operational playbooks.
• Serves as a strategic thought partner to senior leadership on reimbursement trends payer dynamics healthcare innovation and long-term growth opportunities.
• Understands the complex interplay between reimbursement technology operations documentation and the patient experience in driving sustainable healthcare models.
• Thrives in high-growth environments characterized by evolving services shifting regulations state-by-state policy nuances and emerging care delivery models.

Required Qualifications

• 8 years of experience in medical reimbursement payer policy analysis provider coding or regulatory research.
• Demonstrated expertise in CPT/HCPCS/ICD-10 coding and payer policy interpretation.
• Experience with telehealth maternal health services or multi-state reimbursement environments.
• Strong understanding of Medicare Medicaid and commercial coverage policies.
• Experience evaluating reimbursement feasibility for new clinical or educational services.
• Advanced skills synthesizing policy coding and compliance into recommendations for senior leadership.

You might also have

• Coding certifications such as CPC CPB CCS CRC or similar.
• Experience with perinatal or womens health services (e.g. lactation doula CHW PT).
• Familiarity with payer negotiations or working alongside payer relations teams.
• Experience with virtual care delivery and hybrid clinical product models.
• Background supporting multi-service multi-state healthcare organizations.
• Working knowledge of documentation workflows EHR systems and billing logic automation.

What Aeroflow Offers

Competitive Pay Health Plans with FSA or HSA options Dental and Vision Insurance Optional Life Insurance 401K with Company Match 12 weeks of parental leave for birthing parent/ 4 weeks leave for non-birthing parent(s) Additional Parental benefits to include fertility stipends free diapers breast pump Paid Holidays PTO Accrual from day one Employee Assistance Programs and SO MUCH MORE!!

Here at Aeroflow we are proud of our commitment to all of our employees. Aeroflow Health has been recognized both locally and nationally for the following achievements:

• Family Forward Certified
• Great Place to Work Certified
• Inc. 5000 Best Place to Work award winner
• HME Excellence Award
• Sky High Growth Award

If youve been looking for an opportunity that will allow you to make an impact and an organization with unlimited growth potential we want to hear from you!

Aeroflow Health is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race color sex religion sexual orientation national origin disability genetic information pregnancy or any other protected characteristic as outlined by federal state or local laws.

We value transparency and candidate safety throughout the hiring process. Aeroflow recruiters may reach out through platforms such as LinkedIn or Indeed; however all interviews and/or offer coordination and sensitive information requests will occur only through our official communication channels. You will never be asked to provide personal data outside our secure application portal and all interview or offer details will come from an @ email address. We do not conduct interviews via text message or instant-messaging apps. If you have concerns please contact our Talent Acquisition team for verification

Required Experience:

Exec