Healthcare Reimbursement Expert Consultant

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Summary

This professional is a Market Access and Business Development executive with broad experience in related strategy development and implementation. He has led the creation of billions in aggregate market potential for numerous healthcare products and services across diagnostic tests, medical devices and pharmaceuticals and has a deep understanding of major worldwide healthcare payment systems, honed through years of hands-on, practical experience and study. He has contributed as a leader in the overall strategic planning and successful commercial operation of healthcare-focused companies (both manufacturer and provider side), and in driving not only market opportunity, but also direct revenue and business growth delivery with hundreds of millions in documented revenues.

Highlights
• Healthcare market access expert
• Global healthcare payment system expert
• Market Access start-up company experience
• Reimbursement Strategy for Manufacturers and Providers
• Health Economics and Outcomes Research
• Medical Device Regulatory

Relevant Accomplishments

  • Provided expert advice and guidance to multiple Medical Device manufacturers relative to their market access, reimbursement, revenue cycle management, and commercialization strategies; Implemented strategies with outreach to customers and other stakeholders in the value chain.
  • Gained access to HighMark VITAL Innovation Program for a mid-sized medical device company
  • Led negotiations with CMS – Leveraging personal relationships was able to convince the agency to set pricing for company’s product at target rate.
  • Led efforts with commercial and governmental payers to establish coverage and value-based payment for business unit that is currently part of a molecular diagnostic company. Implemented the overarching payer and commercialization strategy; Led the business unit to coverage and payment by Medicare and other payers fueling the business unit’s rapid growth from < $10M per year to $120M per year. This success led to the acquisition by Myriad Genetics.
  • Led the effort for insourcing the organization’s billing and collection’s program fully managing the P&L
  • Frequently presented to the Board on reimbursement and related commercialization strategies
  • Build the Corporate Market Access & Payment Policy Function for BD’s Diagnostic unit. This included analysis, planning, hiring, and partnering with ongoing ROI tracking.
  • Created the SMART Global Market Access Program, collaborating with regulatory to incorporate a holistic view of market access needs early and ongoing within the product development cycle.
  • Developed and achieved passage of key legislation of important Medicare program reform provisions.
  • Created numerous billing diagnosis codes for numerous products, leading end-to-end processes for the creation of 8 CPT codes, 4 ICD-9 codes, and 1 HCPCS code.

Roles

    • VP, Business Development and Market Access
    • VP, Payer Markets & Reimbursement
    • Corporate Director, Worldwide Payment Policy
    • Managing Care Executive

Education/Certifications

    • MBA, Finance
    • BS Chemistry, Biochemistry emphasis
    • Certificate – Cytotechnologist

Request Expert / Similar Expert

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To apply for this job email your details to dmagnani@maexecsearch.com