Reimbursement Director

Exempt: Yes

Department: Commercial

REIMBURSEMENT DIRECTOR

About Baudax Bio

Baudax Bio is a specialty pharmaceutical company focused on developing and commercializing innovative products for acute care settings. The Company has multiple investigational non-opioid therapeutics in clinical development for the treatment of pain conditions and is currently developing their lead candidate, IV Meloxicam, a proprietary, long-acting preferential COX-2 inhibitor for the treatment of acute post-operative pain with plans to file a New Drug Application (NDA) in early 2019.

Our pipeline also includes other early-stage product candidates, including two neuromuscular blocker agents (NMBs) and a related proprietary chemical reversal agent, and Dex-IN, a proprietary intranasal formulation of dexmedetomidine, a selective alpha-2 adrenergic agonist that is being developed for its sedative, analgesic and anxiolytic properties.

We believe we can create value for patients and shareholders through our robust pipeline of product candidates. In addition, we continue to evaluate acquisition and licensing opportunities which align with our core acute care focus.

Position Summary

The Reimbursement Director will be responsible for reimbursement policy decisions related to CMS and to help develop government coding and billing strategies, executing on tactics and deliverables, managing consultants, and monitoring CMS regulations and interpreting legislation. The scope of responsibilities will include identifying policy challenges and opportunities, supporting policy development aimed at securing access to therapies for patients. The individual will work closely with the Baudax Leadership team, commercial operations and patient services functions. The reimbursement Director will be a direct liaison between the reimbursement HUB, sales, and our customers.

Success in this role will include building the reimbursement readiness of the area teams, delivering on the market access reimbursement strategy, and ensuring providers have access to the information necessary to remove barrios in the overall reimbursement process.  This position will also support field sales leadership by coordinating strategy that supports a variety of personnel within ambulatory surgery centers (ASCs) and hospital outpatient settings.  The Field Reimbursement Director will be directly responsible for the time sensitive market development and implementation of the coverage and reimbursement strategy that will maximize patient access. This role is critical and time sensitive in the pre and post launch strategy with large key payer targets, including large national commercial insurers and government payer

Education and Experience

Required:

  • Bachelor’s degree
  • A minimum 10 reimbursement experience.
  • 2-4 years of direct management preferably in biologic/injectable/infusible drug space

Preferred:

  • Advanced degree or specific Practice Management/Supervisory Leadership experience preferred
  • Launch experience as a 1st line leader highly desirable
  • Prior experience managing Field Reimbursement desirable
  • Minimum of 7 years’ field biologics experience, ideally with injectable drugs
  • ASC experience preferred
  • In depth knowledge of C-code and J-code billing system
  • 2-3+ years of reimbursement and account management experience preferred
  • Minimum of 4-5 years’ experience in: practice management, or practice billing and revenue cycle

Principle Duties and Responsibilities

  • Serve as a liaison to certain internal teams, working closely with the Commercial Leadership, to keep company apprised of policy priorities and to engage colleagues in providing directional input
  • Lead the development and implementation of access focused tools and resources such as payer value propositions, billing and coding guides, economic models and other relevant access resources for the Baudax Portfolio
  • Forecast and Analyze coverage policies, claims, and government policies to determine opportunities, threats and performance within our markets
  • Provide coaching and guidance to Regional Business Directors and Directors of National Accounts on billing and coding strategy, market access strategy, landscape insights/trends and resource implementation
  • Collaborate with the training team to maintain training materials for coverage, coding, reimbursement and the market access landscape for the Spectrum portfolio
  • Provide input on related strategies such as clinic and hospital GPOs, Channel/Distribution, Specialty Pharmacies, pricing/contracting and HCP targeting
  • Reimbursement (billing & coding) expertise on manufacturer products across all payer types: commercial, Medicare and Medicaid
  • Provide reimbursement support to physicians and billing/office managers including knowledge of billing and coding systems
  • Identify prospective opportunity or coverage issue and support a central patient centric HUB / patient services assisting with out of pocket help from multiple areas
  • Participate in special projects and perform other duties, as required
  • Maintain strong technical expertise in areas related to CMS and HHS, i.e. Medicare, Medicaid, 340B; federal rulemaking processes; health care policy development; public payor coverage, coding, and payment; price reporting policy and healthcare compliance rules
  • Monitor, interpret and assess all CMS rulemaking, guidance issuances and related health policy developments
  • Proactively identify challenges and risks and execute against Baudax’s health policy priorities
  • Support collateral working with internal teams to review/tailor materials as needed day-to-day
  • Grow visibility in the policy arena by representing the organization on the policy committees of relevant trade associations
  • Cultivate strong working relationships with partner colleagues at Baudax HQ, including the senior Leadership, sales, finance and market access
  • Oversee internal issue education, working closely with counterparts to identify area of need and to execute trainings
  • Manage consultants, ensuring that their expertise is fully utilized and that deliverables are timely and of high-quality

Working Environment

  • Good driving record
  • Ability to drive during the daytime and nighttime
  • Ability to travel overnight for 3-4 nights per week (drive or fly); 65% travel

 

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