Manager, Reimbursement and Payment Policy

At Johnson & Johnsonwe believe health is everything. Our strength in healthcare innovation empowers us to build aworld where complex diseases are prevented treated and curedwhere treatments are smarter and less invasive andsolutions are our expertise in Innovative Medicine and MedTech we are uniquely positioned to innovate across the full spectrum of healthcare solutions today to deliver the breakthroughs of tomorrow and profoundly impact health for more at

As guided by Our Credo Johnson & Johnson is responsible to our employees who work with us throughout the world. We provide an inclusive work environment where each person is considered as an individual. At Johnson & Johnson we respect the diversity and dignity of our employees and recognize their merit.

Job Function:

Market Access

Job Sub Function:

Reimbursement

Job Category:

Professional

All Job Posting Locations:

Palm Beach Gardens Florida United States of America Raynham Massachusetts United States of America Remote (US) Warsaw Indiana United States of America Washington District of Columbia United States of America West Chester Pennsylvania United States of America

Job Description:

We are searching for the best talent for a Manager Reimbursement and Payment Policy to join our Orthopaedics team. The role will ideally be located in Palm Beach Gardens FL Raynham MA Warsaw IN Washington D.C. or West Chester PA however remote work options may be considered on a case-by-case basis and if approved by the Company.

Purpose:

This role is designed for a professional with 510 years of professional experience in coding coverage and payment policy within the MedTech sector who can work independently and manage programs and vendors. The Manager will partner with cross-functional teams to deliver reliable reimbursement support policy monitoring and field enablement initiatives that drive market access for innovative orthopaedic technologies. This is an individual contributor role with no direct reports.

You will be responsible for:

CMS Payment Policy Support

• Support the Director in developing and executing payment policy strategy for the Orthopaedics portfolio across Medicare payment systems including IPPS/MS-DRGs OPPS/ASC and the Physician Fee Schedule.
• Conduct research and analysis to inform coding coverage and payment positioning for both pipeline and in-line products including DRG APC and code assignment questions.
• Assist in the preparation of reimbursement assessments for new product launches and lifecycle management.

Policy Monitoring & Analysis

• Monitor and analyze CMS proposed and final rules along with Medicaid and commercial payer policy updates and summarize implications for internal stakeholders.
• Track changes in DRG CPT/HCPCS coding ASC/HOPD payment systems and emerging reimbursement trends.
• Develop concise summaries executive alerts and briefs that translate policy updates into actionable insights.

• Manage multiple projects and deadlines tied to the CMS rulemaking calendar and annual coding cycles and communicate status and risks to leadership.

Reimbursement Hotline & Vendor Management

• Own day-to-day management of the Orthopaedics Reimbursement Hotline (phone and email) including vendor oversight service levels response quality and escalation handling.
• Manage the end-to-end hotline vendor relationship including performance review and contract and scope management.
• Ensure hotline operations comply with applicable healthcare compliance privacy and company policies in partnership with Legal Compliance and Privacy.
• Analyze inquiry logs to identify trends in customer needs coding questions and payer issues and report insights and recommendations to HEMA and Commercial leadership.
• Promote awareness of hotline services with field teams and customers and set metrics to measure utilization and customer satisfaction.

Coding Guides Reimbursement Tools & Field Education

• Lead the annual update and lifecycle management of coding and reimbursement guides FAQs and customer-facing resources across joint reconstruction trauma spine sports medicine and related portfolios.
• Ensure all guides reflect current CPT HCPCS ICD-10-CM/PCS MS-DRG and APC information as well as CMS payment rates and rule changes and are accurate compliant and timely.
• Manage the content review and approval process with Legal Regulatory and Compliance and maintain version control and a publication calendar.
• Design and deliver training for sales marketing and customer-facing teams on coding coverage and payment and translate policy updates into practical field guidance.
• Partner with cross-functional teams to keep reimbursement websites and resource libraries current and easy to navigate.

External Engagement & Advocacy Support

• Assist the Director in drafting comment letters and background materials for CMS and other stakeholder engagements.
• Support preparation for interactions with external stakeholders (e.g. specialty societies trade associations payer groups).
• Conduct landscape assessments to support advocacy positions and policy strategy development.

Cross-Functional Collaboration & Evidence Integration

• Partner with Health Economics and Epidemiology teams to support development of evidence strategy to facilitate reimbursement and access.
• Provide reimbursement inputs for Target Product Profiles (TPPs) and early-stage pipeline discussions.
• Synthesize clinical economic and real-world evidence to inform coverage strategies.

• Collaborate with Commercial Regulatory Legal and Compliance to ensure reimbursement information and programs meet company and regulatory standards.

Education and Experience:

Required

• Bachelors degree in Health Policy Health Economics Public Health Business or a related field.
• 510 years of relevant experience in reimbursement health policy market access or healthcare consulting preferably in the medical device or life sciences industry.
• Working knowledge of U.S. reimbursement systems including Medicare payment structures (IPPS/MS-DRG OPPS/ASC Physician Fee Schedule) and coding frameworks (CPT HCPCS ICD-10-CM/PCS).

• Experience interpreting CMS regulations and translating them into business implications and written materials such as comment letters or executive briefs.
• Experience managing vendors programs or customer support operations including performance metrics and compliance requirements.

• Strong analytical research project management and problem-solving skills with the ability to work independently and manage multiple priorities.
• Excellent written and verbal communication skills with the ability to explain complex policy to technical and non-technical audiences.
• Ability to work effectively across cross-functional teams in a matrixed environment.

Preferred

• Advanced degree (e.g. MPH MPP MBA).
• Experience in MedTech orthopaedics or surgical technologies.
• Familiarity with CPT/HCPCS coding CMS rulemaking and payer policy development processes.

• Experience with reimbursement hotlines field reimbursement or coding and reimbursement education.
• Coding credential (e.g. CPC CCS) or equivalent practical coding expertise.

About Orthopaedics

Fueled by innovation at the intersection of biology and technology were developing the next generation of smarter less invasive more personalized treatments.

Are you passionate about improving and expanding the possibilities of Orthopaedics Ready to join a team thats reimagining how we heal Our Orthopaedics teams help keep more than 6 million people moving each year while delivering clinical and economic value to surgeons and healthcare systems. Our teams build solutions for joint reconstruction; trauma and craniomaxillofacial; sports extremities and elective foot and ankle; spine; and robotics and digital surgery.

Your unique talents will help patients on their journey to wellness. Learn more at & Johnson announced plans to separate our Orthopaedics business to establish a standalone orthopaedics company operating as DePuy Synthes. The process of the planned separation is anticipated to be completed within 18 to 24 months subject to legal requirements including consultation with works councils and other employee representative bodies as may be required regulatory approvals and other customary conditions and approvals. Should you accept this position it is anticipated that following conclusion of the transaction you would be an employee of DePuy Synthes and your employment would be governed by DePuy Synthes employment processes programs policies and benefit that case details of any planned changes would be provided to you by DePuy Synthes at an appropriate time and subject to any necessary consultation processes.

Johnson & Johnson is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity age national origin disability protected veteran status or other characteristics protected by federal state or local law. We actively seek qualified candidates who are protected veterans and individuals with disabilities as defined under VEVRAA and Section 503 of the Rehabilitation Act.

Johnson & Johnson is committed to providing an interview process that is inclusive of our applicants needs. If you are an individual with a disability and would like to request an accommodation please contact us via or contact AskGS to be directed to your accommodation resource.

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Required Skills:

Preferred Skills:

Healthcare Reimbursement Health Policy Analysis Health Policy Research Health Regulations Public Health Policy Development

The anticipated base pay range for this position is :

$102000.00 - $177100.00

Additional Description for Pay Transparency:

Subject to the terms of their respective plans employees are eligible to participate in the Companys consolidated retirement plan (pension) and savings plan (401(k)).

This position is eligible to participate in the Companys long-term incentive program.

Subject to the terms of their respective policies and date of hire employees are eligible for the following time off benefits:

Vacation 120 hours per calendar year

Sick time - 40 hours per calendar year; for employees who reside in the State of Colorado 48 hours per calendar year; for employees who reside in the State of Washington 56 hours per calendar year

Holiday pay including Floating Holidays 13 days per calendar year

Work Personal and Family Time - up to 40 hours per calendar year

Parental Leave 480 hours within one year of the birth/adoption/foster care of a child

Bereavement Leave 240 hours for an immediate family member: 40 hours for an extended family member per calendar year

Caregiver Leave 80 hours in a 52-week rolling period10 days

Volunteer Leave 32 hours per calendar year

Military Spouse Time-Off 80 hours per calendar year

For additional general information on Company benefits please go to: - Experience:

Manager