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TITLE

 

Head of Healthcare Economics and Reimbursement

COMPANY

 

Silk Road Medical

LOCATION

 

Sunnyvale, CA, US

Description

Silk Road Medical, Inc. is a public medical device company located in Sunnyvale, California, that is focused on reducing the risk of stroke and its devastating impact. The company has pioneered a new approach for the treatment of carotid artery disease called TransCarotid Artery Revascularization (TCAR). TCAR is a clinically proven procedure combining surgical principles of neuroprotection with minimally invasive endovascular techniques to treat blockages in the carotid artery at risk of causing a stroke.

 

We are looking for a highly motivated individual to join us as the Head of our Health Economics & Reimbursement team providing leadership in the development, planning and execution of strategic reimbursement for the Transcarotid Artery Revascularization (TCAR) procedure and any new procedures designed and developed in the future.  Our current focus is in the United States with a goal to expand to international markets.

This role is focused on the development and implementation of Health Economics and Reimbursement strategies and tactics for establishing coding, coverage and payment both in the US and in international locations to ensure Silk Road Medical products continue to have a strong value proposition.  Successful performance will include establishing favorable payer coverage, ensuring fair and consistent payment, and removing barriers in the overall reimbursement process.

This position will report directly to the CFO, who currently leads our efforts in this area, and will be a member of the senior staff.  The successful candidate will manage a budget and build a team necessary to support related activities.  He / she must demonstrate excellent communication and collaboration skills, a strategic, innovative mindset, and high level of competence in reimbursement and health economics for medical devices.

Key Responsibilities: 

  • Drive reimbursement strategy for Silk Road Medical
    • Partner with a cross-functional team to develop and execute Health Economic and Reimbursement strategies and tactics and studies that support Silk Road Medical products strong value proposition.
    • Oversees and conducts the development of relevant outcomes research studies as determined by product evidence generation studies to establish the clinical, economic, and patient centered value propositions related to TCAR.  Designs existing data studies, develops or approves research project plans, and oversees execution.  Selects and works with study vendors.
    • Using a detailed understanding of clinical and economic evidence to support product positioning, develop detailed that cover the product, comparator procedures, market characteristics, and clinical and economic evidence to support reimbursement.
    • Collaborates with internal and external experts in the execution of studies and implementation of field-based, customer-focused initiatives (e.g., models, scientific communications, slide kits, formulary/regulatory dossiers.
    • Develop and implement reimbursement strategies and economic value plans to support physicians by identifying opportunities to partner with hospitals regarding the economics of Silk Road Medical products and programs.
    • Regularly survey the device landscape to understand the dynamics affecting US medical device manufacturers including the impact of key health policy and macroeconomic changes including, but not limited to ACA and MACRA.
    • Responsible for objective setting and regular business review updates specific to health economic and reimbursement deliverables.
  • Drive Reimbursement support for Customers and Sales organization
    • Act as a strategic business partner to the global sales team by providing training and education programs on reimbursement best practices (coding, coverage and payment procedures), health care policy issues to internal personnel including our sales force.
    • Lead the development or improvement of tools utilized by the sales team to effectively communicate relevant healthcare policy information and messages related to Silk Road products.  Maintain / update reimbursement coding guides.
    • Educate, train and support health care providers and hospital administrators on reimbursement topics ensuring solid understanding of coding, coverage and payment procedures.
    • Identify early any reimbursement issues (coding, coverage and payment) and develop solutions to address.
  • Lead Coding, Coverage and Reimbursement strategy development for international markets
    • Assess and communicate the coding, coverage and payment landscape globally. Develop and execute specific strategies to enable optimal reimbursement in target regions and maintain agility to extend reach to new markets as we expand to capitalize on global growth opportunities.
  • Manage relationships with CMS and other Health Care Payers
    • Develop and maintain relationships with key individuals at CMS for coding, coverage and payment concerns.  Plan, arrange and negotiate positive reimbursement environment in direct meetings with CMS.
    • Build relationships and develop plans for patient access to TCAR with private payer accounts.  Develops and consults on global reimbursement strategy and value proposition for payers.
    • Comply with U.S. Food and Drug Administration (FDA) regulations, other regulatory requirements, Company policies, operating procedures, processes, and task assignments. Maintains positive and cooperative communications and collaboration with all levels of employees, customers, contractors, and vendors.
    • Performs other related duties and responsibilities, on occasion, as assigned.

Requirements/Qualifications:

  • Masters or PhD in Health Economics, Outcomes Research, Health Services Research, Pharmacy Administration or related discipline along with proven track record in reimbursement, healthcare economics/policy in medical device, pharmaceutical, biotechnology or hospital setting.
  • Strong, senior level experience in the medical device or similar field, working directly with Health Care Policy
  • An in-depth understanding of coverage, coding and payment models and command of evolving health care landscape in US and Globally.
  • A minimum of 10 years of successful work experience in the medical device or related field with focus on reimbursement, healthcare economics and/or healthcare policy (preferably some experience in all three areas but most importantly will have experience with U.S. reimbursement).
  • Must have proven expertise in reimbursement coding, billing processes and claim submissions to public and private insurers.
  • Experience in collaboration working across a matrix organization with various stakeholders.
  • Must have strong project management skills and experience.
  • Must have polished communication skills including written documentation and oral presentations.

What We Offer You:

  • A collaborative work environment with colleagues who care about each other and the success of their organization
  • A workplace where you are treated fairly, compensated competitively, and can learn and develop your skills
  • A chance to join an industry which is saving lives and changing the shape of healthcare
  • A very fun and supportive environment in a fast-growing organization where there is never a dull moment

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