· 20+ years of experience in the health care industry
· In-depth understanding and training in medical reimbursement, billing, coding, and health policy.
· Extensive knowledge in medical device and pharmaceutical medical policy, coding and reimbursement.
· Specific knowledge with biologicals and medical devices under a "buy and bill" model.
· Experience interacting with large field-based sales force, national accounts, regional sales directors, C-
Suite, regulatory and clinical teams.
· Strong understanding of the Medicare/Medicaid and Commercial plans.
· Self-motivated with a proactive approach collaborating with KOL's, industry leaders, and health plan
Education and Training
Columbia Southern University City, StateHealthCare AdministrationBachelor of ScienceHealthCare Administration 4.0
American Health Insurance Plan (AHIP)
· Professional, Academy for Healthcare Management (PAHM)
Health Policy/Medical Coding/Reimbursement/Sales:
MCO payers, State Medicaid, Government & MAC/CMS channels
Regenerative Medicine, Kidney Dialysis, Wound Care, Pain Management, Mental Health, Medical Device,
Laboratory, Physical Therapy
January 2013 to Current
Company NameSenior Manager
Specialize in strategies and tactics to ensure market access, product coverage and reimbursement
pathways that will positively influence CMS, Medicaid and Commercial payers.
Participate in the implementation of market access preparation and planning in U.S.
and Global markets
related to regulatory and reimbursement pathways.
Specialize in U.S.
and Global market medical dossier and health technology assessment applications.
Communicate and collaborate with CMS, Medicaid and commercial health plan CMO's, Medical Directors,
and medical policy tech committees to educate and request product coverage to gain market access.
Evaluate and analyze key business development needs and partnerships for market access impact with
respect to the requirements given by CMS, Medicaid and commercial payers.
Monitor and address current and future changes in health policy and reimbursement and their effect on
organizational business and product access.
Deep knowledge of payment methodologies with CMS, Medicaid, and commercial payers.
Skilled in extensive research methods related to medical policy regulations for outpatient, inpatient, and
professional services for U.S.
and Global Markets.
Effectively work with internal and external customers to provide full educational product support and
March 2010 to August 2013
Company NameSenior Reimbursement Territory Manager
Biological/medical device field reimbursement and sales support.
Provided reimbursement support in coding, health policy, and policy coverage for sales representatives,
national accounts, hospitals, wound care centers, and physicians.
Managed territory coverage and coding issues for ME, NH, MA, CT, RI, VT, and NY.
Previously covered the
Mid-Atlantic and Great Lakes Regions.
Worked with Medicare Part B, Medicaid, and Commercial payers to educate on product specifications to
ensure coverage and reimbursement.
Enhanced sales skills developed as a result of the desire to have complete product penetration in hospitals,
wound care centers, and physician offices.
Provided educational reimbursement tools to sales representatives, sales directors, national accounts, and
Set strategies with sales team, sales managers, national accounts, and regulatory affairs to remove
reimbursement barriers and provide top notch coding education.
Created and conducted product related education programs for hospitals, wound care centers and physician
Analyzed and provided reimbursement reviews to provide full reimbursement support and target unpaid
claims for hospitals, wound care centers, and private offices.
Followed hotline benefit verifications and watch for inconsistencies or changes in payer outcomes.
Flexibility with overall reimbursement and the constant changes in medical policies.
Focused on team communication and assist other reimbursement specialists in their territories.
Assisted in training new reimbursement specialists and sales representatives in product coding.
Set up visits with hospitals, wound care centers, and physician offices to perform claim assistance, business
reviews, and provided general coding guidance.
Collaborated with field sales team, national accounts, and reimbursement specialists on issues within their
January 1998 to January 2010
Medical Coding and Reimbursement.
Managed a team of 16 medical billing specialists in Pain Management, Laboratory, Physical Therapy,
Mental Health and Family Medicine.
Medical billing/coding professional with 15+ years' experience.
Ensured that appropriate ethical standards, business, and employment practices were communicated.
Negotiated and contracted with medical device vendors that supplied critical surgical equipment.
Negotiated managed care contracts on behalf of surgery center for coverage with commercial payers.
Developed office policies, procedure manuals, and job descriptions relevant to compliant billing and coding
Responsible for hiring, training and mentoring new employees, and completing annual employee reviews.
Prepared periodic financial reports requested by the State or other agencies.
Planned and directed implementation of compliance practices issued by governmental agencies.
Provided support to the accounting department for month end balancing functions.
Provided critical reimbursement support and collaborated with patients, physicians, and clinical staff.
Participated in external and internal audits with attorneys, health payers, and governmental agencies.
Scheduled meetings with physicians on a monthly basis to report financial and productivity information
within the practice.
Posted, adjusted, and tracked over $3M in services per month.
Maintained a high volume workload, performed with absolute accuracy, and met tight deadlines.
Certified Outpatient Coder (COC) American Academy of Professional Coders (AAPC #01184721).
HCPCS Level I, II, III.
Surgery and Modifiers.
Code Assignment ICD-9 and ICD-10.
accounting, billing, business development, CMS, contracts, Dialysis, Family Medicine, financial, financial reports, Government, Healthcare Management, hiring, Insurance, internal audits, MA, MAC, market, Medical billing, Medical Coding, meetings, Mental Health, mentoring, access, office, organizational, Pain Management, Physical Therapy, policies, coding, regulatory affairs, research, sales skills, Sales, sales support, surgery, Wound Care
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Columbia Southern University
Job Titles Held:
Senior Reimbursement Territory Manager
HealthCare Administration Bachelor of Science American Health Insurance Plan (AHIP)
· Professional, Academy for Healthcare Management (PAHM)
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