Clinical Trial Reimbursement Specialist

Summary 

Our client, a Fortune 500 medical device company, has engaged GForce Life Sciences to provide a detail-oriented and knowledgeable Clinical Reimbursement and Pricing Specialist to support the pricing and contracting process by triaging and resolving lower- to mid-level pricing deviations and related issues. The ideal candidate will have 2–4 years of experience in reimbursement and coding, with a strong understanding of healthcare compliance and technical reimbursement processes.

Job Duties

• Review and address lower- to mid-level pricing issues that arise during the contracting process.
• Triage reimbursement-related inquiries and escalate complex cases as needed.
• Ensure compliance with federal, state, and industry reimbursement regulations.
• Apply knowledge of US reimbursement coding, including DRG assignments and APC categorizations.
• Interpret complex disease states and communicate related technical product information effectively.

Requirements 

• Bachelor’s degree in business administration, sciences, nursing or a related field or equivalent work experience
• A minimum of 3 years’ experience involving coverage policies, procedures and regulations including but not limited to: Clinical and AdvaMed Code of Ethics on Interactions with Health Care Professionals.
• Experience with US reimbursement coding, Diagnostic Related Group (DRG) assignments, Ambulatory Payment Classification (APC) categorization and process.
• Demonstrated knowledge of federal, state and industry rules and regulations governing technical aspects of reimbursement and compliance
• Ability to understand complex disease states and technical product information
• Advanced personal computer skills, including experience with Microsoft Office
• Experience with budget and contract negotiations.

Preferred Requirements

• Experience in international reimbursement

Term & Start 

• Contract through end of the year, possibility of converting FT
• 100% Remote