Director of Payer Relations at ROMTech (2024-11 – Present)
- Develop target National/ Regional accounts strategy and reimbursement toolkit for increased sale
- Review Accts Receivables/Payables, wrote letters for Denial/Appeals
- Work with Sales and their KOL's
- Schedule appointments with CMO's with favorable results
- Apply for coding
- Strategize Policy Topics
- Work with teaching hospitals - Cleveland Clinic, Shands, Brigham Mass General Hospital
- Developed an internal Payer Relations regional team
- Executed payer and utilization management guideline inclusion strategy
- Market access strategy of legacy, new product entrants and potential acquisitions, under development products
Director of Market Access at Great Lakes Neurotechnologies (2022-02 – 2024-12)
- Executed payer and utilization management guideline inclusion strategy
- Contact Commercial Payers, CMS payers for contracts supporting their clinical advisory team
- Educate the significance of KinesiaU for their Parkinson's patients working through their Neurologist
- Support the application with MAC's
- Attend all conferences meeting KOL, CMO, Nurse practitioners
- Market access strategy of legacy, new product entrants and potential acquisitions, under development products
- Developed effective reimbursement strategy and reimbursement toolkit for increased sales
National Director of Health Policy/ Reimbursement at RTI Surgical – Cortiva (2019-03 – 2022-01)
- Executed payer and utilization management guideline inclusion strategy
- Schedule virtual conference calls with CMO for our clinical teams to speak peer to peer
- Developed strategy for quarterly outcomes to overturn experimental policy
- Meet Payers to include Cortiva as Medically Necessary Worked with CMS for positive policy decisions
- Worked hand in hand with regulatory
- Meet with KOL for the support Cortiva for presentations to CMO
- Developed strategies to meet vendors to include Cortiva
- Worked with Hospitals/ coding audits to support positive reimbursement explored to change National, Lg regional payer Policies
- Developed effective reimbursement strategy and reimbursement toolkit for increased sales
East Coast Market Access/ Reimbursement/ Policy at Vascular Insights-CleriVein (2015-02 – 2019-02)
Start up provider of Vascular specialty catheter
- Supported 1 regional LCD with MAC's for commercialization
- Introduced 2 national payers to Vascular Insights to review negative policy (peer to peer)
- Secured 15 commercial payers to review their non-scheduled policy review
- Supported 8 NE regional sales reps, working with their key opinion leader associations with reimbursement billing, and payments including appeal & denials
- Developed effective reimbursement strategy and reimbursement toolkit for increased sales
- Work with KOL to support appointments with payers to influence policy for peer to peer presentations
- Support Sales teams with billing managers and support positive claims
Director of Reimbursement at Dilon Diagnostics (2011-09 – 2015-02)
- Responsible for all aspects of market access, policy reviews, and contracting for positive reimbursement
- Overturned one National Payer Policy who listed us as (experimental/ investigational)
- Secured one MAC -LCD which was viewed by other MAC/ BCBS
- Development of Reimbursement e-learning tools on coding, coverage and payment to educate and apply subject matter for providers
- Developed effective reimbursement strategy and reimbursement toolkit for increased sales
VP of Payer Relations at ANS- St. Judes (2008-04 – 2011-09)
Promoted
- Secured three National Managed Care agreements for this diabetic device (4.9M lives)
- Developed internal Call Center for intake & verification. Hired, trained staff of 8
- Assisted in development and execution of strategies for Health Policy & Reimbursement department
- Built and expanded relationships with key opinion leaders
Reimbursement Manager Central Region at Advanced Neuromodulation Systems (ANS) (2006-06 – 2008-02)
St. Jude's acquisition
- Responsible for twenty state regions educating key accounts. Sales support to 12 reps for this manufacture of implantable spinal cord stimulators
- Acquired national managed care agreements for favorable operational revenue
- Increased region sales quota from 13.5M to 18M. Awarded Central Region of the year
- Monitored coverage and payment policy with payers to determine if reimbursement produced operational revenue to meet quarterly projected financial goals
- Monitored coverage and payment policy with Managed Care /Case Managers
- Communicated with commercial/Medicare payers to obtain initial positive payer approval for ongoing positive coverage
- Worked with GI physicians to assist their practice with proper coding, and reimbursement
National Director of Payer Relations at CARDIONET, INC. (2003-06 – 2006-06)
Startup Company
- Responsible for new contracts with all commercial Payers including contract negotiations, closing, executing, and implementations
- Proactively integrated new published peer-reviewed clinical studies to gain positive medical policies
- Interfaced directly with Medical Directors and key decision makers to obtain positive coverage for this diagnostic device
- Secured the one and only policy with Humana which resulted into an agreement of 15 M Lives
- Acquired two national managed care agreements (Humana/Aetna)
- Monitored coverage and payment policy with payers to determine if reimbursement produced operational revenue to meet quarterly projected financial goals
- Managed reimbursement department of 6 with three regional managers
- Gained 6 payer appointments for peer to peer to overturn negative policy with C-level management payers to obtain initial positive payer coverage and ongoing positive coverage
- Secured 4 Self Insured agreements (1.6 M lives)
- Developed effective reimbursement strategy and reimbursement toolkit for increased sales
- Established relationships with Medical Directors of national and regional payers to gain approval of MCOT
- Implemented reimbursement strategies that proactively integrated existing published peer reviewed clinical and economic studies
