GIRS Team
Overview
The Global Integrated Reimbursement Services, Inc. team includes experts with a wide range of complementary skills to ensure market uptake of pharmaceuticals, medical devices, surgical supplies and diagnostics. These skills range from reimbursement, marketing, health economic modeling, and clinical outcomes development skills. Our professional profiles are presented below.
Professional Profiles
Sajini Thomas, President, Ms. Thomas has several years of experience as a senior executive in the medical technology field. Her experience and expertise, in both the private and public sector, includes strategic planning, market research and analysis; third-party payment planning and implementation; health care policy and research; and product launch and payer advocacy for drugs, devices, biologics, lab tests, combination products, and surgical supplies. Sajini held positions as Vice President of The Lewin Group, Director of Reimbursement for Wright Medical Technology, Inc., a global orthopaedic and orthobiologics company, and for two DC-based consulting firms. She has also worked for Covance, one of the world's largest and most comprehensive drug development services companies. Sajini earned a Masters in Health Services Administration from the University of Michigan at Ann Arbor, a Masters in Sociology from the Delhi School of Economics, in India, and has completed a Wharton/Windhover Executive Education Program for Pharmaceutical and Biotechnology Executives.
Ms. Thomas has managed and participated in several US-based and international reimbursement initiatives for drugs, biologics, and diagnostics including reimbursement strategies for a Tissue product, xenografts, cell based technologies, monoclonal antibodies, joint replacement devices, advanced wound care therapies, drug device combinations, and several diagnostics including breath tests to detect H. Pylori, molecular diagnostic tests, diagnostic tests to identify viral infections, and other types of nosocomial infections.
Ms. Thomas has managed several customized hotlines for a wide range of technologies in the US, developed customized programs for key accounts, negotiated with payers in the US for coverage of individual claims and for the development of coverage policies, obtained the support of key professional societies included the AAOS, and worked over 16 years with CMS to obtain billing codes and coverage support.
Marilyn Denegre Rumbin. MBA, was formerly the Regional Manager- Reimbursement & Payor Relations, DePuy Spine, Inc. She was responsible for 15 states in Northeast and Atlantic Region. She was responsible for identification of reimbursement issues, coding, coverage and payment in support for new emerging technologies at the grass roots level. She developed and implemented pull-through plans for key customers. She also was responsible for the development and delivery of educational updates for field sales organization. Ms. Rumbin developed economic strategies and tools for coverage and reimbursement. Her recent key achievements are as follows:
- Developed and maintained an external network of thought leaders in US, e.g. AMA, CMS, Specialty Societies, AHA, AHP, Large Integrated Delivery systems, Employer Groups, Federal and State Medicaid and government, State Bar Associations to leverage legislation issues for obtaining medical policies.
- Implemented special reimbursement projects for other DePuy franchises to ascertain medical policy and clinical design process, including special projects for medical devices, therapeutics and pharmacology.
- Developed and implemented education programs for Case Managers, Adjusters and Medical Directors that successfully influenced 23 positive medical policy decisions.
- Directed grassroots projects, including presentations to surgeons to obtain written endorsement by regional and state Orthopedic, Neurosurgery and Spine Societies.
- Achieved Johnson & Johnson ENCORE Gold Award for 9 written medical policies from July 2005 to December 2005.
- Achieved Johnson & Johnson ENCORE Gold Award for 42 written individual considerations for overturning appeals with payers in 2006.
- Special recognition for exceeding productivity by 120%, with appeals, policies, 23 payer meetings, education programs, in addition to presentations, over 500 surgeon and hospital meetings in 2006.
- Delegated representative for Johnson & Johnson Political Action Committee, responsible for communication, campaign updates, contribution campaign including presentation to board members of DePuy franchises.
Key Areas of Expertise: Regional payer relations tasks, regional accounts and sales force assistance, managed care contracting, private payer research, Medicaid Managed Care Research, grass roots health economic strategies.
Martha Weiner Loewenthal, PhD, was a Senior Manager at Blue Cross and Blue Shield of Illinois and was responsible for network expansion; new provider group contracting; design, preparation and dissemination of hospital and drug utilization reports; and liaison with provider groups. She added five medical groups/IPAs in target areas during the first year, redesigned utilization and prescription drug reports to highlight cost effectiveness of providers and served as a member of Pharmacy & Therapeutics Committee which introduced Open Formulary to HMOI. She has several years of experience helping pharmaceutical and medical device companies research and position new products to ensure market uptake. Key Areas of Expertise: Managed Care Contracting, Payer Advocacy, Reimbursement Strategies.
Gita Smith, MS, MBA has completed several coding certification programs and has over 20 years of experience working for large contract research organizations (CROs) managing and operating all phases and functions of reimbursement hotlines. She also has operated Reimbursement Hotlines and Patient Assistant Programs for the following disease areas: Hemophilia, Hemapheresis, AIDS/HIV, Organ Transplant, CMV Retinitis, Epilepsy, Cancer (several areas), Alzheimer's, Imaging devices, Parkinson's Disease, Obesity, ESRD, Laser technology, Osteoporosis, and vascular access devices. She has handled hotlines that averaged from 55-65 calls per day to as many as 95-100 calls per day. She has developed reimbursement guides, coding sheets, drafts of payer letters, and prepared the monthly reports, and trained and supervised junior staff. Key Areas of Expertise: Payer Mailings, Payer Advocacy, Hotline Management and Operation, Sales Force Education and Support, Pharmaceutical and Medical Device Reimbursement.
Pamela Cieplak, RPH, MBA specializes in Medicaid research and provides a wide range of marketing and sales support to health care firms. She brings several years of experience analyzing and disseminating Medicare and Medicaid coverage and reimbursement regulations. She has several years of experience working for large CROs to support their medical technology hotlines. She also has developed clinical education programs and developed several billing guides and other educational materials. She has worked with major pharmaceutical companies such as Bristol Myers Squibb, CV Therapeutics, Genentech, Genzyme, NitroMed and Par Pharmaceutical. Key Areas of Expertise: Medicaid Fee - for - Service Research and Strategies, Pricing Strategies.
Medicare Policy Consultant Medicare Consultant with several years of experience conducting preliminary coding and reimbursement analysis and monitoring policy development for specific products among public and private payers. Medicare, Medicaid and private insurer policy analysis and healthcare regulation monitoring. Key Areas of Expertise: Payer Mailings, Payer Advocacy, Policy Research, Medicare Part D, Hotline Management and Operation, Sales Force Education and Support, Coding Applications, and Pharmaceutical and Medical Device Reimbursement.
Tracey Fuentes BA has trained under Sajini Thomas and Gita Smith for several years to handle medium and low volume hotlines. She is proficient with all coding systems and billing requirements for several technologies, including vascular access. She has excellent customer service skills and is proficient with handling call logs and documenting trends in the hotline database. She has previously worked with major insurers in the area of benefits verification. Key Areas of Expertise: Payer Mailings, Payer Advocacy, Hotline Operation and Management, Sales Force Education and Support.
Alvin Long, BA is a seasoned professional with more than 12-years experience in the health care field. Alvin has worked for industry leaders such as Covance Health Economics & Outcomes Services Inc. (consulting) and insurance carriers such as UniCare (formerly John Hancock Life & Health) and Blue Cross Blue Shield. He possesses outstanding interpersonal, human relations and relationship-building skills. His administrative, client management, training and education abilities are superb. His consulting experience consists of providing strategic reimbursement assistance to the medical industry and individuals through hotline administration. In addition, for insurance carriers, his experience consists of developing a physician and hospital network and providing benefit information via the Federal Employee Program (FEP) for domestic and international subscribers. Key Areas of Expertise: Payer Mailings, Payer Advocacy, Hotline Operation and Management, Sales Force Education and Support.
Belinda Mendoza is a seasoned and dynamic marketing executive and business developer with more than 20 years of combined experience in the pharmaceutical and medical device industries. She has impacted performance through skillful strategies, enhancement, and coordination of marketing efforts. She achieved superior levels of revenue growth and product visibility. Ms. Mendoza is an advanced communicator with all levels of personnel, management, and clients She has served as an instrumental contributor to corporate profitability, multiplying sales revenues through skillful orchestration of innovative marketing strategies. She has boosted product sales from $200K to over $20M annually in 5 years by working with the client throughout design, implementation, and marketing of a highly innovative program. Key Areas of Expertise: Medical Technology Marketing
Ronald J. Shannon has a diverse background with over twenty years of experience in epidemiology, global market development, clinical outcomes research, health economics, product development and commercialization, informatics market development, telehealth, project management, statistical analysis, medical and scientific research, pharmaceutical sales and marketing and total quality leadership in health care. He also is familiar with global pharmaceutical pricing and reimbursement. Key Areas of Expertise: Health Economics to Support Reimbursement Strategies, International Reimbursement.
Joan Leslie Gilhooly, MBA, CHCC, Certified Healthcare Compliance Consultant, 2000 CPC, American Academy of Professional Coders, 2000, is an expert coder for diagnostics and lab services and skin substitute products. She has broad-based knowledge of physician billing and compliance, practice management, managed care and MSO operations. Key Areas of Expertise: diagnostic and skin substitute coding and practice management.
Robin J. O' Hara, is a website search engine optimization (SEO) expert. He prepares website for Internet marketing. He has functioned as an Internet expert since 1996 and his skills have evolved with the search engines. He has helped several medical device and surgical supply manufacturers with Internet marketing of their technologies including Kestrel Wound Products Sourcebook and Argentum Medical, LLC. Key Areas of Expertise: Internet marketing of medical technologies and services.
In addition to the above team members, we also have the support of reimbursement legal experts, additional hotline staff, and a panel of current medical directors of managed care organizations. Our payer panel information is presented below:
Payer Panel
GIRS can conduct phone based primary research with a Payer Panel that includes current medical directors of large plans, pharmacy benefit managers (PBMs) and pharmacy directors. Important details regarding our Technical Expert Panel are presented below:
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In addition, GIRS can conduct additional primary research with the help of Internet based panels. These panels include medical directors of smaller plans.