
Director, Health Economics & Reimbursement
Edwards Lifesciences
Summary
The Director, Global Health Economics and Reimbursement is a field-based role responsible for working directly with hospital executives, cardiovascular service line leaders and physicians to ensure they recognize the economic and clinical value of the transcatheter heart valve (THV) therapy. They will work directly with hospital leaders and physicians to deliver hospital economic analyses customized to each provider. This individual will also support the health care providers in obtaining optimal reimbursement (payment rates and market access) by serving as a knowledgeable resource in coding, coverage and payment, as well as, an intermediary to payers including Center for Medicare Services (CMS) and/or Medicare Administrative Contractors (MAC), Medicaid, Veteran Affairs (VA) and commercial payers.
Job description
The Director, Global Health Economics and Reimbursement will reside in either Minnesota or Michigan and support field activity in the MN, WI and MI markets. The role will report to the Sr. Director West, Global Health Economics and Reimbursement.
How you'll make an impact:
- Ensure THV value messages are consistently developed and delivered, and customer feedback on value proposition is communicated to internal THV leadership. This will necessitate a competence in developing, synthesizing, and presenting health economic analytics.
- Establish and maintain effective working relationships with key stakeholders at hospitals engaged in THV procedures, including hospital executives, cardiovascular administrators, quality, finance, documentation integrity, billing, and physicians (interventionists and surgeons), to support the site in establishing and maintaining a THV program through the development and implementation of reimbursement plans (coding, coverage, payment) unique to each provider.
- Articulate a thorough understanding of the structural heart landscape, trends, and market insights. A strong understanding of the commercial and government payor landscape including coverage policies and payment processes. This will include managing and addressing coverage policy issues with payors, as necessary.
- Understand health economic and quality content: billing, coding, payment, coverage, policy, hospital finances, structural heart program innerworkings, cath lab and OR processes, clinic, and procedural expertise, etc.
- Identify needed additional expertise and quickly assimilate information and communicate trends, clinical research, policies, etc. and how they will impact TAVR/Structural Heart business. Identifies market trends and customer needs and supports development of strategies and resources for their customers and team.
- Manage demands and needs of multiple programs and customers. Provide high touch program support and build access to key leaders within each organization.
- Build a strategic relationship and serve as a supporting role to our aligned business partners including sales, marketing, government affairs, and medical/clinical affairs.
- Assist our Regional and Territory Sales Managers in the development, implementation, and management of strategic initiatives within geography.
- Perform other duties and responsibilities as assigned.
What you'll need (Required):
- Bachelor's Degree or equivalent in a life science, health economics, health policy, or related field plus 12 years of experience in health policy, health economics, medical device reimbursement and technology assessment or master's degree plus 10+ years of related experience, or equivalent work experience based on Edwards criteria.
- Basic understanding of medical and clinical research methodologies, including the ability to interpret scientific publications and apply evidence to support product value propositions.
- Demonstrated business acumen and analytical thinking, with experience collaborating cross-functionally with teams such as Sales, Marketing, Clinical, Regulatory, Legal, and Government Affairs to address economic and reimbursement considerations.
- Foundational knowledge of health economics and reimbursement, including familiarity with billing, coding, payment systems, coverage policies, and hospital financial operations related to structural heart programs and procedures.
- Ability to travel up to 50% domestically
What else we look for (Preferred):
- Minimum of 5 years of work experience in a field based, consultative, or administrative role within the healthcare industry.
- Reimbursement and/or sales experience.
- Strong understanding of the commercial insurance landscape and relevant reimbursement processes. A solid understanding of public payer programs, e.g., CMS, including coverage, coding, and payment policies.
- Ability to build and maintain strong relationships with hospital leaders and physician customers.
- Proficient in Microsoft Office Suite (i.e., Excel, PowerPoint, Word, Outlook).
- Excellent interpersonal skills, written and verbal communication skills, especially presentation development and delivery in person and virtually. Must be confident, articulate and have professional speaking abilities.
Requirements
- Bachelor's Degree or equivalent in a life science, health economics, health policy, or related field plus 12 years of experience in health policy, health economics, medical device reimbursement and technology assessment or master's degree plus 10+ years of related experience, or equivalent work experience based on Edwards criteria.
- Basic understanding of medical and clinical research methodologies, including the ability to interpret scientific publications and apply evidence to support product value propositions.
- Demonstrated business acumen and analytical thinking, with experience collaborating cross-functionally with teams such as Sales, Marketing, Clinical, Regulatory, Legal, and Government Affairs to address economic and reimbursement considerations.
- Foundational knowledge of health economics and reimbursement, including familiarity with billing, coding, payment systems, coverage policies, and hospital financial operations related to structural heart programs and procedures.
- Ability to travel up to 50% domestically
Benefits
- Competitive salaries
- Performance-based incentives
- Comprehensive benefits programs
Company overview
Edwards Lifesciences (NYSE: EW) is the leading global structural heart innovation company, driven by a passion to improve patient lives. Founded in 1958 and headquartered in Irvine, California, the company specializes in developing breakthrough technologies for cardiovascular diseases. As a pioneer in the medical device industry, Edwards focuses on transcatheter heart valves, surgical heart valves, hemodynamic monitoring systems, and vascular solutions. The company's patient-focused culture inspires its 16,000+ employees worldwide to deliver life-changing innovations that address complex heart health challenges. Edwards serves patients in over 100 countries through its comprehensive portfolio of products including the SAPIEN transcatheter heart valve system, INSPIRIS surgical valves, and advanced monitoring technologies. With a commitment to research and development, the company invests 17-18% of its revenue back into R&D efforts, maintaining its position at the forefront of structural heart innovation. Edwards Lifesciences has impacted over one million patients globally through its transformative medical technologies.