LymphaPress, an industry-leading and award-winning organization specializing in home compression therapy products, has recently added a mission-critical role to our team as a Market Access, Payer Relations and Audit Coordinator focused on payer relations, contracting, audits and appeals. This role will be responsible for the coordination of all aspects of insurance network contracting, contract renewals, contract initiation, recredentialing, contract negotiations and execution, and payer audits. This role will:

• Create a strategic plan outlining the timeline of milestones and payer engagement activities
• Identify target payers based upon an initial analysis of payer policies, relationships, regional launch markets and other factors
• Obtain favorable payer coverage positions for target payers
• Participate in and act as the point of contact for all Medicare ALJ Hearings

• Coordination with Company’s internal personnel/physician advocates/KOLs to support payer engagement with medical directors/review committees
• Secure webcasts, teleconference calls or in-person meetings from target payer list for the purpose of obtaining favorable payer coverage positions
• Provide electronic information to payers, including published articles, clinical data, dossier, and/or relevant medical coverage policies from relevant payers as needed/requested
• Potential engagement with consultant medical directors or other advisors to assist in payer messaging/ evidence reviews/ payer outreach

• Review initial material/evidence review (FDA, clinical evidence, current dossier, medical policy/guidelines)
• Draft/refine the payer value proposition
• Develop payer presentations

• Assist Company on reimbursement-related tasks (coding/coverage/payment issues) pertaining to Company’s products
• Continued education and updates on payer medical coverage policy, reimbursement strategy, and clinical messaging
• Request reviews, updates and/or revisions to existing payer coverage position statements when it is determined that a Payer does not adequately cover the technology
• Coordination with Company’s vendors, third-party contractors, or other consultants in support of project goals
• Assist Company in locating/hiring qualified reimbursement personnel as appropriate to build a team as needed

The ideal candidate for this new role will possess a Bachelor’s degree, minimum of 1 year of relevant audit and appeals, contracting and payer relations experience in a medical device industry. Leading candidates will also have the following skills and qualifications:

• Preferred existing relationships with target payers and national medical directors
• Knowledge/experience working in medical office environment and with medical insurance (billing, authorizations, etc.) with multiple payers.

• Ability to complete the daily activities associated with appealing denied Medicare claims in addition to all duties associated with audits (RAC, TPE, ZPIC, etc.) for documentation and billing compliance, including the participation in Administrative Law Judge (ALJ) proceedings.
• Ability to demonstrate a strong understanding of CMS requirements and regulations related to Medicare DME
• DME experience is preferred and certainly a plus
• Proficient in commonly used office software programs, including Microsoft 365 and the ability to learn new software systems

• Knowledge of Federal and State regulations, guidelines, and standards, including working knowledge of HIPPA rules and regulations
• Possess the ability to interact professionally and ethically with third parties including insurance plans, patients / caregivers, and referral sources
• Ability to handle multiple tasks simultaneously
• Ability to provide clear, concise oral and written directives/communications
• Experience working on government, Recovery Audit Contractor (RAC), Medicare Administrative Contractor (MAC), Targeted Provider Education (TPE), Comprehensive Error Rate Testing (CERT), and other regulatory audits

Serving patients nationally, we are committed to making a difference in the lives of those we serve by putting our core values (SCRIP) into action through:

• Solving problems
• Being Courageously kind

• Redefining possibilities through quality
• Inspiring others
• Putting people first

If you're seeking an organization with a great culture, we have much to offer! We are honored to be certified as a Great Place to Work and to be recognized by Philly Top Workplaces and Fortune Magazine as a top employer in our industry! We offer a competitive compensation and benefits package. Apply today to become a valued member of our growing team! EEO/AAP