SetPoint Medical’s Sr. Manager of Field Reimbursement will lead and manage a comprehensive reimbursement support program for the first neuroimmune modulation therapy to treat rheumatoid arthritis in the US. As the first non-pharmacologic treatment for rheumatic disease, this disruptive technology has the potential to improve the lives of people living with chronic autoimmune disorders.  

The Sr. Field Reimbursement Specialist serves a critical role on the market access team, as the primary point of contact ensuring hospital and physician-claim payment. This includes establishing and executing best practices in new customer onboarding, coding/reimbursement training and conducting claim payment follow-up and business reviews. Success in this role effectively manages reimbursement expectations and outcomes across SetPoint Medical’s rheumatology, surgical practice and hospital customers. With the support of an experienced management team, industry-leading IT infrastructure and a corporate culture built on flawless execution, the Sr. Manager of Field Reimbursement will have the opportunity to set a new standard in the medical device industry for what a Market Access program can be. This position will report to the VP of Market Access.

•Lead and manage a team of field reimbursement specialists to support rheumatology, surgical practice and hospital/ASC value analysis and reimbursement outcomes

•Develop reimbursement/value analysis messaging platforms, including presentations and economic value, as well as customer support models for claim payment issues

•Serve as an executive-facing subject matter expert for value analysis committees, supply chain leaders, and clinical stakeholders

•Identify payment trends and build analytics to support our value proposition

•Provide claims support and follow-up, including claim review, denial analysis, appeal strategy, and payer communication

•Educate customers on appropriate coding, billing, and documentation requirements for device-related procedures

•Complete corporate administrative and training requirements on time and accurately.

•Maintain company standards involving ethical and moral character, and always represent the company with the highest professional standards.

Minimum Qualifications

•At least 4 years’ experience working in medical device reimbursement, market access, healthcare consulting, accounts receivable or claims follow-up in a medical device company, healthcare provider, or third-party billing service provider.

•Ability to manage workload, delegate and build teams, either with direct reports are in a matrixed organization

•Experience with claims follow-up for commercial and governmental payers

•Awareness of, or ability to quickly learn, the medical policy and coverage landscape for vagus nerve stimulation.

•Knowledge of the claims appeal processes that include electronic and paper claim appeals and external review, ALJ.

•Experience with HIPAA compliance standards for covered entities.

•Understanding of hospital billing workflows, ancillary systems (OR systems, materials master files, charge routers, etc.) and ability to learn and use IT systems such as EPIC, Cerner, etc.

Skills and Abilities

•Successfully build relationships with healthcare providers and billing staff (including revenue cycle and billing/A/R staff).

•Ability to work independently and manage claim adjudication follow-up for hospital and physician providers.

•Manage complexity and re-prioritize work efforts to drive efficiency and outcomes.

•Ability to understand trends, identify issues and develop corrective actions.

•Ability to thrive in a fast-paced, dynamic startup environment, with a willingness to adapt to changing priorities and market conditions.

•Passion for improving patient outcomes and a commitment to the company's mission and values.

Physical Requirements

•Prolonged periods of sitting at a desk and working on a computer.

•Must be able to lift up to 15 pounds at times.

Work Location and Travel

•This is a hybrid position requiring regular in-office presence at company headquarters in Valencia, CA, with approved remote workdays permitted in accordance with company policy. 

•Minimal travel within the US (up to 20%) required.  

Company Description

SetPoint Medical is a commercial-stage medical technology company dedicated to improving care for people living with chronic autoimmune diseases.

Department: Market Access

Reports To: VP, Market Access

FLSA Status: Exempt
Location: Hybrid (based in Valencia, CA)

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification form upon hire. Candidates must have and maintain authorization to work within the United States as a condition of employment.

We are proud to be an equal opportunity employer and we value diversity. SetPoint does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, disability, national origin, veteran status or any other basis covered by appropriate law. All employment is decided on the basis of qualifications, merit, and business need.