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Manager, Payer Relations

  • United States
  • Full Time

About the Job

The Payer Relations and Reimbursement Manager is responsible for the development of the Medicaid segment and supporting overall access/coverage of this segment to Foundation Medicine’s Product Portfolio. The position works cross functionally with internal and external stakeholders to ensure an expansive access, broaden coverage and payment associated with this segment, understand Medicaid policy, secure enrollment, understand Medicaid coding, understand regulations and reimbursement at the individual state level, and communicate Medicaid and Managed Medicaid analyses internally. This role works directly with states, Managed Medicaid plans, and payer account directors to establish access at the state level and within managed Medicaid plans. The role requires collaboration with all stakeholders by engaging the health care ecosystem and creating new pathways while working towards company goals and demonstrating FMI values. 

Key Responsibilities

  • Manage the Medicaid segment on both a state and national level to understand and support expansion of coverage polices and reimbursement.
  • Collaborate with internal stakeholders to ensure acceleration of state Medicaid coverage and enrollment in 50 states, plus the District of Columbia, for all FMI products by 2028
  • Collaborate intra- and inter-departmentally to pull through Managed Medicaid coverage, reimbursement and appropriate claims adjudication. 
  • Strategically prioritize and segment work on an individual state Medicaid and Managed Medicaid level
  • Collaborate with Government Affairs to understand updates to state regulations and reimbursement that are important to FMI
  • Complete state enrollment applications, maintain data and submit re-enrollments as required per state laws.
  • Analyze and maintain summaries of state Medicaid Fee schedules, inclusive of billing codes and regulations influencing pricing.
  • Participate in industry coalitions which support efforts to provide access to comprehensive genomic profiling (CGP) for Medicaid beneficiaries.
  • Collaborate to select vendors and build vendor work plans which support accelerated state Medicaid coverage and enrollment goals
  • Other duties as assigned.

Qualifications:

Basic Qualifications:

  • Bachelor’s Degree (life sciences/policy preferred)
  • 5+ years’ experience working in the Medicaid and health sector
  • 5+ years’ experience working in a healthcare environment

Preferred Qualifications:

  • Master’s degree with focus on Health Policy or related field id preferred but not a must
  • Experience with Excel and PowerPoint and creating reports
  • Experience using Salesforce and/or project management tools such as Smartsheet
  • Ability to execute on assigned projects to meet business goals
  • Proficient in data analytics
  • Understanding of policy work supporting patient access to care
  • Ability to project plan and keep all stakeholders informed of business-critical updates
  • Excellent communication skills-written and verbal
  • Project management skills and capabilities
  • Understanding of HIPAA and importance of privacy of patient data
  • Commitment to reflect FMI’s values: Patients, Collaboration, Innovation, and Passion

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About Foundation Medicine

Foundation Medicine 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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Internal applicants, please use your FMI email address.

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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)

To all recruitment agencies: Foundation Medicine does not accept agency resumes. Please do not forward resumes to our jobs alias, Foundation Medicine employees or any other organization location. Foundation Medicine is not responsible for any fees related to unsolicited resumes.

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