ABOUT US
EDAP is the Global Leader in robotic energy-based therapies pioneering ultrasound innovations that transform patient lives. With a dedicated team of 300+ professionals across 50+ countries, we are at the forefront of disrupting the status quo in prostate cancer care and beyond. Our Focal One robotic platform, the first of its kind, utilizes High-Intensity Focused Ultrasound (HIFU) for targeted therapy, ensuring patients experience excellent oncologic control with fewer side effects and a quicker overall recovery. We are seeking a highly skilled and experienced Director of Reimbursement and Market Access to join our team and drive the market access strategy for our growing portfolio of products. The successful candidate will play a pivotal role in ensuring that our products are successfully integrated into the healthcare system, with optimal reimbursement and broad access for patients.
POSITION SUMMARY
The Director of Reimbursement & Market Access will be responsible for leading the strategy, development, and execution of reimbursement and market access initiatives for EDAP's medical technology products within the U.S. This role will involve collaborating with key stakeholders, including payers, healthcare providers, and regulatory bodies, to ensure that our products are accessible and reimbursable across various healthcare systems. Primarily focused on payor coverage for our CPT 55880 code, the individual should also play a major role in maintaining economically rewarding payment rates as well as design coding and overall market access strategies for upcoming products and clinical indications. The Director of Reimbursement & Market Access will work closely with EDAP executive leadership to develop and implement priority-based strategies to increase payor coverage on a case-by-case basis while rapidly gaining coverage policies to support the Company's growth objectives. He/she will partner cross-functionally with Clinical, Sales, and other internal departments as well as physician offices, hospitals and external consultants to ensure result-driven alignment on reimbursement strategy.
MAJOR FUNCTIONAL RESPONSIBILITIES
Reimbursement Strategy Development
- Designs and implements Company's Reimbursement and Market Access strategies to ensure timely and appropriate reimbursement for new and existing products.
- Works closely with cross-functional teams (clinical, regulatory, marketing, sales) to align product development and launch plans with reimbursement needs.
Market Access and Pricing
- Leads market access efforts by identifying key payers and managing relationship to secure favorable reimbursement terms for EDAP's products. Develops and implements pricing strategies that align with market dynamics, payer requirements, and company objectives.
- Develops and implements comprehensive market access strategies to ensure timely and optimal reimbursement for new and existing products across multiple payer channels (e.g., private insurance, Medicare, Medicaid).
- dentifies key payer and policy trends, assesses market dynamics, and designs proactive market access strategies to drive product adoption and reimbursement.
- Collaborates with cross-functional teams (R&D, Clinical, Regulatory, Sales, Marketing) to integrate reimbursement and market access considerations into product development and commercialization plans.
- Leads payer engagement efforts, including interactions with private payers, Medicare, Medicaid, and other third-party stakeholders.
- Develops market access evidence generation plans, including conducting health economics studies, value dossiers, and market access models to support reimbursement efforts.
Reimbursement & Policy Advocacy / Payer Relations
- Monitors reimbursement trends and healthcare policies at the local and national levels to anticipate challenges and opportunities.
- Advocates for coverage and reimbursement decisions with payers and regulatory agencies, ensuring that products are properly valued and reimbursed.
- Manages strategy to obtain Medicare coverage throughout the country, either on a case-by-case basis or via Coverage Decisions / Policies.
- Manages Reimbursement Hotline Services whether provided by third party or internal resources
- Drives Payor Outreach effort.
- Tracks existing coverage decisions and policies from MACs and commercial payors.
- Establishes and executes strategy to request and obtain coverage decisions and policies of major payors (MACs and Commercial Payors).
- Attends MACs open meetings and discusses HIFU technology with decision makers (Medical Directors).
- Collaborates with Guidelines and Healthcare Technology Assessments to promote the integration of HIFU in the various Prostate Cancer Guidelines (NCCN, AUA, Evidence Street, etc.).
- Ensures optimal reimbursement codes for the procedures associated to company's technologies are assigned and maintained in the long run.
Compliance and Documentation
- Ensures all reimbursement strategies and activities are compliant with relevant healthcare regulations and standards.
- Leads the preparation of required documentation for reimbursement submissions, including health technology assessments (HTAs), coding, and pricing submissions.
Cross-Functional Collaboration
- Partner with the regulatory affairs team to ensure market access and reimbursement requirements are considered in regulatory submissions.
- Work with sales, marketing, and medical affairs teams to ensure market access tools and resources are aligned with the company's commercial strategy.
- Provide input into the development of product value propositions, marketing strategies, and customer engagement materials.
- Serve as a subject matter expert on reimbursement and market access within the company, providing guidance on the payer landscape and business development opportunities.
Data Analysis and Reporting
- Monitors payment levels for facility and physician fees on a regular basis
- Supports either via direct interaction or via consulting firm's physician and hospital users in their coding, billing and getting coverage from public (Medicare) and Commercial payors
- Manages pro-actively payment level strategy to increase payment levels for both hospital and physician
- Meets with CMS and other stakeholders to advocate for adequate payment levels if necessary
- Elaborates or otherwise maintain up to date all reimbursement-related documents (billing guides, Executive Summaries, Medical Necessity template letters, etc.)
- Tracks, identifies all scientific literature relevant to EDAP's technology as well as competitive technologies or techniques. Updates supporting reimbursement documents accordingly
- Trains and supports EDAP's field teams (sales, clinical support, marketing) on any reimbursement-related topics.
Position-Specific Skills
- 8-10 years of relevant and current work experience in medical device reimbursement and market access, including successes in obtaining coverage for innovative technologies, ideally in urology.
- Built high expertise in complex reimbursement projects, leading to coverage success for a procedure/technology resulting in fast accelerated growth and adoption.
- Established relationships with key payers, policy makers, and industry influencers.
- Strong understanding of health economics, health technology assessments (HTA), and economic modeling to support reimbursement strategies.
- Proven experience in developing market access strategies, payer engagement, and managing reimbursement submissions.
- Knowledge of industry best practices and emerging trends in market access
- Excellent communication, negotiation, and presentation skills, with the ability to influence decision-makers and stakeholders at all levels.
- Adaptable and able to thrive in a fast-paced environment with a continuous improvement mindset.
Leadership Skills Required
- Ability to lead cross-functional teams and collaborate effectively with various stakeholders as part of a high-performing team.
- Takes initiative to call out needed system changes, and shares recommendations for improvement.
- A strong internal and external customer focus and service orientation.
- Authentic and approachable personality that can connect with a diverse range of people.
- High sense of integrity, professional courage, sound judgment and sense of urgency.
- Has the personal confidence and emotional intelligence necessary to engage with a strong leadership team.
Technical Skills Required
- Proficient in Excel, Word, Outlook, PowerPoint and other business operating systems.
Education/Training Required
- Bachelor's degree in life sciences, healthcare, business, or a related field required.
- Advanced degree in business (MBA) or Public Health (MPH) preferred.
- 8-10 years of experience in reimbursement, market access, or healthcare strategy, ideally in urology and/or gynecology within the medical device industry.
- In-depth knowledge of reimbursement and market access strategies, including payer dynamics and policy development across public and private sectors.