Associate Director, Market Access & Reimbursement - Alpharetta, GA or Remote

Requisition ID: 6896

Job Title: Associate Director Market Access & Reimbursement - Alpharetta GA or Remote

Job Country: United States US

Here at Avanos Medical, we passionately believe in three things:

Making a difference in our products, services, and offers never ceasing to fight for groundbreaking solutions in everything we do. Making a difference in how we work and collaborate constantly nurturing our nimble culture of innovation. Having an impact on the healthcare challenges we all face and the lives of people and communities around the world.

At Avanos, you will find an environment that strives to be independent and different, one that supports and inspires you to excel and to help change what medical devices can deliver now and in the future.

Employment for customer-facing roles is contingent upon your ability to satisfy all vendor credentialing requirements. If you are unable to be credentialed, Avanos reserves the right to withdraw your employment offer or end your employment. If you require a medical or religious accommodation from these requirements or if you would like to understand more about these requirements, please advise HR, so that we can provide additional information and, if needed, we can explore any needed accommodations.

Avanos is a medical device company focused on delivering clinically superior breakthrough solutions that will help patients get back to the things that matter. We are committed to creating the next generation of innovative healthcare solutions, which will address our most important healthcare needs, such as reducing the use of opioids while helping patients move from surgery to recovery.

Headquartered in Alpharetta, Georgia, we develop, manufacture, and market recognized brands in more than 90 countries. Avanos Medical is traded on the New York Stock Exchange under the ticker symbol AVNS. For more information, visit www.avanos.com.

Essential Duties and Responsibilities

The Associate Director of Market Access, Reimbursement, and Medical Policy is a customer-facing role responsible for developing and implementing U.S. reimbursement strategies that affect current and future products across Avanos Specialty Nutrition Systems and Pain Management portfolios. The position will work closely with the business units to drive and develop market access initiatives that support Avanos priorities.

Key responsibilities include:

• Coding and payment analysis across various settings (Physician, Hospital, Outpatient, and ASC)
• Insurance coverage prior authorization and appeals support
• Cost-effectiveness evaluations
• Collaboration on reimbursement methodologies across both government payers (e.g., Medicare, Medicaid, and commercial insurers)
• Analysis of procedures, services, and durable medical equipment (DME)

20-40 travel. Prefer relocation to Alpharetta, GA, although not required.

Purpose of the Position

Develops strategies to optimize the reimbursement landscape to include coding, payment, and coverage from third-party payers (CMS, other government payers, and healthcare customers) for Avanos Medicals entire product portfolio, including key brands such as MIC-KEY, ON-Q, ambIT, GAME READY, and Interventional pain IVP management products (TRIDENT and COOLIEF cooled radiofrequency technology, etc.).

Manages the national Market Access Reimbursement and Health Policy teams with multiple direct reports.

Leads efforts to directly market payment and reimbursement opportunities and market access value propositions with payers, providers, and value analysis committees to drive sales growth.

Develops critical relationships with physicians and payers to drive appropriate clinical utilization on medically necessary patients and, therefore, sales of products.

Supports commercial reimbursement initiatives in collaboration with Sales and Marketing, working closely with Clinical Affairs.

Key Responsibilities

• Manages and leads the national Market Access Reimbursement and Health Policy team with multiple direct reports.
• Recruits, develops, and leads the performance of employees to develop programs aligned with market access reimbursement and health policy.
• Leads the market access reimbursement and health policy teams in developing and regularly updating reimbursement and health policy tools for use with sales physicians, facilities, and payers.
• Establishes goals aligned with Avanos organizational plans and strategic imperatives, driving execution through mentoring and leadership.
• Develops Avanos national payer strategy to market the value proposition of products directly to payers to secure favorable product reimbursement.
• Provides strategic expertise to Sales and Marketing to develop and execute plans that drive revenue growth and reach appropriate patient populations.
• Collaborates with clinical functions on evidence generation strategy and needs to support market access and company goals.
• Monitors and analyzes changes in the external reimbursement environment, assesses associated risks and opportunities, and communicates portfolio impacts with recommended action plans.
• Develops and manages reimbursement collateral tools, communications, and content development to drive sales growth for appropriate patients.
• Educates internal teams on market access topics and reimbursement changes, delivering through training programs and field sales engagement to properly educate customers on the benefits of Avanos products for appropriate medically necessary patients.
• Develops critical relationships with physicians and payers to adopt clinical utilization of IVP, TRIDENT, & COOLIEF, ambIT, ON-Q, GAME READY, and enteral feeding products.
• Builds and formulates collaborative relationships with Avanos functional departments and serves as a liaison to external stakeholders.
• Drive facility and provider network development by providing market access reimbursement and medical policy expertise to executive teams of healthcare systems, hospitals, physicians, independent joint-venture, and ASC management companies.
• Influence appropriate government agencies and healthcare payers to obtain appropriate coding coverage and payment.
• Interact with the American Medical Association and CMS to obtain coding and coverage for new modalities, procedures, and product codes.
• Provides expertise on state and federal regulations for reimbursement methodologies and appropriate coding for SNS and Pain Management products.
• Manages and directs the monitoring of third-party resources and data that may be utilized to drive the creation of analyses.
• Serves as the internal and external subject matter expert on market access reimbursement and medical policy matters for SNS and Pain Management products.
• Integrates health economics considerations into reimbursement and market access strategies to support sustainable patient access.
• Complies with U.S. Food and Drug Administration (FDA) regulations, other regulatory requirements, company policies, operating procedures, processes, and task assignments.
• Maintains clear and effective communication and positive cooperative collaboration with internal and external stakeholders at all organizational levels.
• Supports budget management and planning for department program spend.
• Performs other related duties and responsibilities as requested.

Reporting Relationships

Direct report to the Vice President Global Marketing.

Current positions reporting to this leader include:

• Field Reimbursement Managers
• Payor Engagement Manager
• With dotted line leadership responsibility to two Reimbursement Patient Access Specialist Managers.

External Interface:

• Health Insurers (both government and commercial)
• Third-party billing companies
• Current and potential customers
• Industry Trade Associations
• KOLs (Key Opinion Leaders)
• Professional medical societies
• CMS (U.S. governmental agencies)

Internal Interface:

• All business groups within the organization

Qualifications

Required:

• Bachelors degree required.
• 10 years of medical device reimbursement, including DME third-party billing experience and strategic marketing experience.
• Medical device industry experience required.
• Broad-based knowledge in medical device and DME market access reimbursement, patient access, payer coverage, policy, employee management, business management, project management, marketing, and extensive experience in general healthcare.
• Demonstrated clinical acumen through interface with various physicians.
• Ability to drive appropriate payment coverage of products by payers.
• Strong communication, interpersonal, and analytical skills.
• Proficient in the use of Microsoft PowerPoint, Excel, Windows, and Microsoft Office.
• Experience with data visualization software (e.g., Tableau) and CRM applications (e.g., Salesforce.com) or aptitude to learn such tools.
• General ability to learn and acclimate to new systems.

Excellent leadership qualities.

Persuasive, self-driven, and motivated.

Strong analytical and presentation skills.

Innovative and resourceful.

Preferred:

• MBA desirable.

The statements above are intended to describe the general nature and level of work performed by employees assigned to this classification. Statements are not intended to be construed as an exhaustive list of all duties, responsibilities, and skills required for this position.

Salary Range

The anticipated average base pay range for this position is $160,000.00 - $185,000.00. In addition, this role is eligible for an attractive incentive compensation program and benefits. In specific locations, the pay range may vary from the base posted.

LI-Remote

Avanos Medical is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, sexual orientation, gender identity, or any other characteristic protected by law. If you are a current employee of Avanos, please