PAYOR REIMBURSEMENT SPECIALIST
SCOPE OF POSITION
Zionexa is a dynamic and growing international company, developing and commercializing molecular imaging companion diagnostics (CDx’s) for targeted therapies in Oncology that will help clinicians find the right treatment for the right patient at the right time. Our goal is to improve patients’ pathways and overall quality of life.
The FDA has approved Cerianna (Fluorestradiol F-18) a molecular imaging agent for use in Positron Emission Tomography (PET) imaging for the detection of estrogen receptor-positive lesions as an adjunct to biopsy in patients with recurrent or metastatic breast cancer. Cerianna is the 1st FDA approved F-18 PET imaging agent specifically indicated for use in patients with recurrent or metastatic breast cancer.
This is an exciting time for Zionexa as we begin our journey. Come be a part of an outstanding international team, one that is striving to make positive impacts in peoples’ lives. As we begin with the launch of Cerianna, we are looking for an experienced Payor Reimbursement Specialist, to join us on our journey in a best in class reimbursement support services team.
The Payor Reimbursement Specialist will support hospitals, medical centers, oncologist offices and oncology specialists in obtaining access to Cerianna. The position will ensure proper access and understanding of services and support as it relates to Cerianna and future Zionexa products. The position will support the company and reimbursement strategies within their region.
ESSENTIAL DUTIES & RESPONSIBILITIES:
- Work closely with cross functional teams within the company to include Sales and Medical Specialists acting as a process and payer subject matter expert in efforts to support the various healthcare providers dealing in Oncology.
- Execute the strategic plan for Cerianna and other Zionexa products access and reimbursement initiatives within the defined customer market.
- Work closely with PETNET Solutions and other partners as assigned in their region to ensure maximum coverage and customer knowledge within their accounts.
- Provide process, payor and specialty support services in collaboration with Sales and Medical Specialists to educate Oncologist Offices regarding coverage of Cerianna in an effort to streamline the coverage and processes to obtain Cerianna.
- Establish and maintain knowledge regarding the local and national payor market including Utilization Management, Radiology Benefit Managers (RBM’s), and other criteria affecting Cerianna.
- Serve as the regional reimbursement resource for targeted customer accounts providing both technical and practical advice to avert and resolve reimbursement issues and support patient access across the region.
- Demonstrate functional understanding of national and local payor payment trends, the Insurance/Payor regulatory environment, policies and relationships to assist product adoption and sales growth.
- Establish relationships within the targeted healthcare provider market to assist healthcare professionals in resolving payor coverage issues that may affect access to Cerianna and other products, in compliance with Zionexa policies, processes and SOPs.
- Ensure individual training and knowledge are maintained to guarantee that personnel are current and up to date in the industry regarding access and reimbursement across the current and future markets.
- Work closely with outside contractors and HUB support center.
- Conduct reimbursement presentations to provide reimbursement information as well as local payer status updates.
- Assist with projects as may be needed.
- Prefer a degree in Science, Healthcare, Regulatory or a Business related field. Some college along with related experience of 5+ years may be considered.
- Certified Professional Coding Certification a plus.
Job Knowledge, Skills & Experience
- Minimum of 3 years’ experience in health and payment policies, practices and reimbursement.
- Knowledge and experience working with ICD9/ 10 coding.
- Experience and knowledge with CMS policies and processes.
- Prior experience with oncology or medical imaging products preferred.
- Experience in working with cross functional environment including Sales, Regulatory, Clinical, Legal, Finance, IT and other areas.
- Excellent communication, organization, analytical, problem solving, data entry and computer/
PC skills to include Office 365, CRM software (Salesforce) and group collaboration applications.
- Requires, knowledge of Commercial Insurers, Managed Care, Government and Federal payor sectors
- Will require extensive travel some of which will require overnight stays. Some international
travel may also be required.
- Valid state drivers’ license, insured and with a clean driving background.
- Strong customer service focus.
- Occasional occupational exposure to radiation.
- Occasional exposure to moderate environmental variations, above average noise levels, and/or some unpleasant substances.
Physical Demands (The physical demands described are representative of those that must be met by an employee to successfully perform the essential functions of the job).
- Will require domestic travel some of which may require overnight stays.
- Light to moderate physical exertion, including occasional standing, bending, reaching, lifting, sitting for extended period of time and the ability to carry light to moderate loads of up to 40 pounds.
Zionexa offers a comprehensive employee benefits program including a 401(k) with match, Life, STD, LTD, Health, HSA, Dental, Vision, Vacation, Sick Time….
At Zionexa, we embrace diversity in our principles, culture and our values. Zionexa is proud to be an Equal
Opportunity employer. As such, we do not discriminate based on race, religion, color, national origin, gender, gender identity, gender expression, sexual orientation, age, disabilities, protected veteran or other protected characteristics.
To ensure equal employment opportunities to qualified individuals with a disability, Zionexa, U.S. will make reasonable accommodations for the known disability of an otherwise qualified individual, unless undue hardship on the operation of the business would result.
Recognizing that it will not be possible to respond to every applicant expressing interest, and we will reach out only to those meeting the qualifications, we thank you in advance for your interest in Zionexa.
Keep watching our website as we continue to grow!
Please no phone calls or emails to any employee of Zionexa regarding any position opening. To all Agencies, resumes submitted by search firms/employment agencies to any employee at Zionexa by email, internet or in any form and/or method will be deemed the sole property of Zionexa, unless a search firm/employment agency was engaged by Zionexa for a particular position and a valid agreement with Zionexa was in place. Should a candidate who was submitted outside of the Zionexa agency process be hired, no fee or payment of any kind will be paid.