About the Job
The Director, Payer Relations & Reimbursement works with Regional and National Health Plans focused in the South Central and West. The 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 individual 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.
• Assist the Vice President of Payer Relations & Reimbursement to set strategic vision for assigned payer targets, assist with payer related medical policy 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 conclude 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.
• 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.
• Approximately 30 to 35% field and meeting travel required, pending COVID.
• Other duties as assigned.
• Bachelor's degree
• 8+ years of experience within Payer/National Accounts and/or Corporate Accounts in oncology and/or laboratory testing
• Advanced degree or healthcare certification(s) a plus
• Extensive experience (12+) in Oncology, Diagnostic and/or healthcare industry
• 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
• 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
• Experience and a proven track record with personalized medicine products or services is a plus
• Demonstrate the ability to work effectively with cross-functional teams in a fast-paced, multi-dimensional organization
• Strong project management and negotiation skills
• Ability to take initiatives and act independently exercising strong business judgement within the scope of the role
• Must demonstrate highly refined analytical and communication skills and 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
Internal applicants, please use your FMI email address.
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