Consultant, Clinical Reimbursement and Pricing Specialist, Medical Devices
Summary
Our client, a Fortune 500 medical device company , has engaged GForce Life Sciences to provide a detail-oriented and knowledgeable Clinical Reimbursement and Pricing Specialist to support the pricing and contracting process by triaging and resolving lower- to mid-level pricing deviations and related issues. The ideal candidate will have 2–4 years of experience in reimbursement and coding, with a strong understanding of healthcare compliance and technical reimbursement processes.
Job Duties
· Review and address lower- to mid-level pricing issues that arise during the contracting process.
· Triage reimbursement-related inquiries and escalate complex cases as needed.
· Ensure compliance with federal, state, and industry reimbursement regulations.
· Apply knowledge of US reimbursement coding, including DRG assignments and APC categorizations.
· Interpret complex disease states and communicate related technical product information effectively.
Requirements
· Bachelor’s degree in business administration, sciences, nursing or a related field or equivalent work experience
· A minimum of 3 years’ experience involving coverage policies, procedures and regulations including but not limited to: Clinical and AdvaMed Code of Ethics on Interactions with Health Care Professionals.
· Experience with US reimbursement coding, Diagnostic Related Group (DRG) assignments, Ambulatory Payment Classification (APC) categorization and process.
· Demonstrated knowledge of federal, state and industry rules and regulations governing technical aspects of reimbursement and compliance
· Ability to understand complex disease states and technical product information
· Advanced personal computer skills, including experience with Microsoft Office
· Experience with budget and contract negotiations.
Preferred Requirements
· Experience in international reimbursement
Term & Start
· Contract through end of the year, possibility of converting FT
· Hybrid in Santa Clara, CA, Sylmar, CA, Maple Grove, MN, Plano, TX, or Burlington, MA (4 days/week onsite)
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