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Associate Director, Payer Relations and Reimbursement

  • United States
  • Full Time

About the Job

The Associate Director, Payer Relations & Reimbursement works with Regional and National Health Plans focused in the North Central. The Associate Director, Payer Relations and Reimbursement functions in a strategic, highly visible leadership position responsible for the identification, development, and management of strategic relationships with payers and organizations that influence payer decision-making. With minimal supervision, this position is responsible for obtaining coverage and reimbursement of the entire FMI portfolio within their assigned accounts. The incumbent enables access to testing that makes a difference for payers and providers and the patients they serve.

Key Responsibilities

  • Assist the Vice President of Payer Relations & Reimbursement to set strategic vision for assigned payer targets to obtain revenue and volume goals for organization.
  • Obtain access of FMI portfolio of products through payer related medical policy & coverage while maintaining current coverage.
  • Negotiate, secure, and manage pull through of new and existing contracts with appropriate Health Plans. Contracts can also include, other managed care organizations (MCOs), value-based agreements, health systems, employers or other government payers that lead to access of care.
  • Establish a strong working relationship with payer customers throughout the health plan organization and healthcare ecosystem and arrange for payer meetings to discuss value of products and partnerships for their members.
  • Develop National and Regional Account plans; conduct appropriate financial analyses and consider impact of applicable regulatory requirements.
  • Work collaboratively with counterparts with sales leaders, clinical teams, billing, legal, and marketing personnel on strategic business development efforts to ensure coverage, access, and reimbursement of products.
  • Interact with senior management and/or multiple decision-makers to execute a positive coverage policy and/or contract negotiation.
  • Serve as liaison between payer customers and company personnel on administrative matters.
  • Work in collaboration with field sales leaders to aid in training and co-promoting the FMI portfolio in their assigned accounts. Participate actively in the preparation and execution of regional field sales plans.
  • Generate forecasts to determine projected return based on coverage and contracts; including estimates of utilization to management, as well as estimates of market potential by product/service/geographic area.
  • Provide feedback to appropriate company personnel regarding payer customer needs and feedback to contract offerings and service.
  • Demonstrate strong working relationship with customers throughout the health plan organization and arrange for payer customer meetings internally and externally.
  • Keep abreast of the payer industry; regulatory, scientific, medical, operational, and marketing plans - incorporating into a strategic approach.
  • Ensure appropriate reimbursement for each line of business reflective of coverage policy and appropriate rates.
  • Represent company at trade shows, scientific or other conferences.
  • Analyze payer customers’ near-term and longer-range needs and requirements promotes - consideration of new or refined company services to meet such requirements.
  • Assist in segmentation of customers and willingness to enter into new markets that enables access and reimbursement to services.
  • Engage and partner with all stakeholders within the health care ecosystem to provide education and ensure access to testing services including (but not limited to) KOL's, employers, LBM's, associations, local ASCO chapters, and patient advocacy groups.
  • Travel up to 30% of the time.
  • Other duties and projects as assigned.

Qualifications

Basic Qualifications

  • Bachelor's degree
  • 7+ years of experience with Health Plans in Regional and National Account in oncology and/or laboratory testing

Preferred Qualifications

  • Advanced degree or healthcare certification(s)
  • 10+ years of experience in Oncology, Diagnostic and/or healthcare industry
  • CRM proficiency: Salesforce.com
  • Proficient with MS Office (e.g. Word, Excel and PowerPoint)
  • Knowledge and a proven track record in Oncology and Laboratory testing
  • Experience and a proven track record with Health Plans both in the private and government sector including coverage policy, contracting, and pull-through
  • Experience and a proven track record with personalized medicine products or services
  • Demonstrated relationships with key payer decision-makers and influencers
  • Demonstrated success with consistent achievement above defined goals & objectives
  • A proven track record of success with special projects and difficult selling scenarios including, but not limited to, adoption of disruptive technologies or transformative products or services
  • Demonstrated ability to work effectively with cross-functional teams in a fast-paced, multi-dimensional organization
  • Proven negotiation skills working with contracts and key customer processes
  • Ability to prioritize and make effective decisions
  • Ability to work independently with minimal supervision
  • Ability to take initiatives and act independently exercising strong business judgement within the scope of the role
  • Excellent verbal and written communication skills
  • Effective presentation skills
  • Strategic and critical thinker
  • Proficient in analyzing, interpreting, and communicating data with the ability to work effectively both independently and in a team environment
  • Understanding of HIPAA and the importance of patient data privacy
  • Commitment to reflect FMI’s values: Patients, Collaboration, Innovation, and Passion

#LI-Remote

 

Please be aware that Foundation Medicine mandates COVID-19 vaccination of all employees regardless of work location. Accommodations may be made in accordance with applicable law.

 

About Foundation Medicine

Foundation Medicine, Inc. (FMI) began with an idea—to simplify the complex nature of cancer genomics, bringing cutting-edge science and technology to everyday cancer care. Our approach generates insights that help doctors match patients to more treatment options and helps accelerate the development of new therapies. Foundation Medicine is the culmination of talented people coming together to realize an important vision, and the work we do every day impacts real lives.

Confidence, or the belief that we need to check every box before applying for a job, can sometimes hold us back from going after a role that inspires us. At Foundation Medicine there's no such thing as the 'perfect' applicant, and our company is a place where every employee can make an impact and continue to grow whatever background they may have or path they may have taken. So, as long as you meet the basic qualifications for a role, please apply if you see a position that would make you excited to come into Foundation Medicine every day and help us transform cancer care.

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Foundation Medicine is proud to be an Equal Opportunity and Affirmative Action employer and considers all qualified applicants for employment without regard to race, color, religion, sex, gender, sexual orientation, gender identity, ancestry, age, or national origin. Further, qualified applicants will not be discriminated against on the basis of disability or protected veteran status. We also consider qualified applicants regardless of criminal histories, consistent with legal requirements. See also FMI’s EEO Statement and EEO is the Law and Supplement. If you have a disability or special need that requires accommodation, please let us know by completing this form.  (EOE/AAP Employer)

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