Manager, Payer Compliance

Overview

At Tactile Medical, we specialize in developing at-home therapy devices to treat lymphedema, chronic venous insufficiency and respiratory illnesses.

• Ensure compliance with all payer requirements.
• Responsible for leading team members charged with the submission of audit responses and associated appeals to commercial and public payers.
• Research, interpret, and stay current on payer policies, guidelines, and regulatory changes from commercial, government, and other payer types.
• Provide input for the creation and refinement of internal policies and processes to align with payer standards and industry best practices.
• Provide regular updates to stakeholders on audit performance and policy changes, escalating unresolved issues as needed.
• Responsible for driving process changes and identifying ways to improve coverage positions through payer audit analysis and appeal arguments.
• Develop and utilize dashboards and reporting tools to evaluate audit outcomes and to measure effectiveness of changes to payer requirements.
• Guide and oversee appropriate training and education for multiple stakeholders including operations, sales force, patients, and clinicians.
• Work collaboratively with all levels of personnel and management to meet company goals.
• Assess departmental capabilities and monitor staff performance to ensure highest output.
• Participate and lead project initiatives, as assigned.
• Maintain compliance with all appropriate regulatory requirements including HIPAA.
• Other duties as assigned.

Required Qualifications

• Education:
  
  Bachelor’s degree in Business, Healthcare Administration, or a related field (or equivalent experience).
• Experience:
  • Minimum 3+ years of leadership experience managing teams or direct reports.
  • Proven experience in payer audits, appeals, and reimbursement processes.
  • Strong understanding of payer methodologies, including coding, coverage criteria, medical terminology, and denial resolution.
• Skills:
  • Excellent analytical and problem-solving abilities; able to leverage data for decision-making.
  • Strong communication skills for interacting with internal teams and external payer contacts.
  • Ability to manage cross-functional collaboration with compliance, finance, and operations teams.
• Technical:
  • Proficiency in reporting tools and dashboards for audit and appeal outcomes.
  • Familiarity with regulatory requirements (e.g., HIPAA).

Preferred Qualifications

• Experience:
  
  5+ years in payer policy analysis, audit management, or healthcare reimbursement.
• Previous experience in medical device industry, health insurance, or healthcare operations.
• Knowledge:
  In-depth understanding of Medicare and commercial payer policies, including NCDs and LCDs.
• Familiarity with fraud, waste, and abuse audit trends and pre-payment review cycles.
• Skills:
  
  Advanced ability to develop strategic solutions for coverage challenges.
• Experience creating educational resources for internal teams and external stakeholders.

Equal Employment Opportunity

Tactile Medical is an equal opportunity employer. We do not discriminate on any protected status under applicable law and we are committed to creating a diverse and inclusive workplace.