Market Access Policy Operations Manager

Position Summary

The Manager of Market Access Policy Operations is tasked with leading the operational infrastructure that supports medical policy intelligence, reimbursement strategy execution, coding analysis, and market access communications and training throughout the organization. This role acts as a strategic partner to several departments including Market Access, HEOR, Government Affairs, Sales, Marketing, Clinical Affairs, and Regulatory teams, ensuring cross-functional collaboration and alignment.

Primary Responsibilities

• Medical Policy Intelligence, Monitoring and Tracking
• Coverage Policy Operations
• Coding and Reimbursement Analysis
• Market Access Communications
• Internal and External Coverage & Reimbursement Policy Education
• Serve as the subject matter expert on coverage, coding, payment, and reimbursement policy
• Develop and deliver education and training to internal stakeholders including Sales, Market Access, Medical Affairs, Marketing, Compliance, Legal, and Executive Leadership
• Provide external education to customers, payer stakeholders, and other healthcare audiences regarding reimbursement and coverage of policy developments and implications
• Translate complex policy changes into actionable business and customer-facing insights
• Serve as Primary Market Access Contact to Smith+Nephew's Reimbursement Hotline and Patient Access and Reimbursement Managers
• Maintain Internal Coverage Database to Support Product Coverage
• Cross-Functional Leadership
• Operational Excellence
• Team Leadership
• Supports reimbursement team communications, marketing materials review and training updates as a subject matter expert

Qualifications

Candidates for this role are required to have a Bachelor's degree, with an advanced degree preferred. Additionally, they should possess between 5 to 10 or more years of experience in healthcare reimbursement, market access, policy, or health economics, reflecting a need for substantial expertise in these areas.

Critical Competencies

• Reimbursement Operations
• Coverage Policy Analysis
• Medicare and Medicaid Policy
• Commercial Payer Policy
• Executive Communication
• Demonstrated comprehensive knowledge of coding, coverage, and reimbursement
• Solid understanding of reimbursement methodologies (e.g., hospital inpatient, outpatient, ASC, physician's office, DME, etc.)
• Understanding of state Medicaid programs and policy development process
• Excellent understanding of medical device industry reimbursement environment (CPT, HCPCS, MAC, LCD, OPPS, MPFS, PDAC, etc.)
• Proven competency in translating complex coverage, coding, and reimbursement policies into clear, actionable training materials and educational programs
• Must possess strong organizational, analytical, and problem-solving skills with a proven track record of working independently (including the ability to develop data models, identify trends, and generate actionable insights from complex data sets)
• Experience working with medical technology datasets: e.g. IQVIA, Policy Reporter, MMIT, etc.
• Expert in tools and techniques of healthcare business analysis including Microsoft Excel and PowerPoint and mathematics

Success Measures

• Work independently and excellent time management skills
• Deliver actionable policy intelligence
• Streamline policy monitoring processes
• Improve field readiness
• Support favorable coverage pathways
• Detail-oriented and data-driven
• Outstanding oral, written, and interpersonal skills
• Good business acumen, innovative thinking, and problem-solving skills

Travel: Up to 30%