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Senior Manager, Payer Relations & Reimbursement

  • United States
  • Full Time

About the Job

Foundation Medicine Inc. is seeking a candidate for the Senior Manager, Payer Relations & Reimbursement position to join our team. This person will work primarily with the IPA’s and Medical groups focused mainly in California. The Senior Manager will function 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 will be responsible for obtaining and pulling though coverage, contracts and reimbursement of the entire FMI portfolio within their assigned accounts. This person will help enable 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 targets; assist with payer related medical policy coverage; negotiate, secure, and manage pull through of new and existing contracts with appropriate IPA's/Medical Groups. 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 organization and healthcare ecosystem and arrange for payer meetings to discuss value of products and partnerships for their members.

•        Develop 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 and Account Executives in the field to aid in training and pull through to ensure access to testing in 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 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.

•        Assist in segmentation of customers and willingness to innovate.

•        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’ associations, local ASCO chapters, and patient advocacy groups.

•        Travel up to 35% of the time.

•        Other duties as assigned.

Qualifications

Basic Qualifications

•        Bachelor’s Degree

•        6+ years of experience within Payer/National Accounts and/or Corporate Accounts in oncology and/or laboratory testing, or related experience

Preferred Qualifications

•        Advanced degree or healthcare certification(s)

•        8+ years of experience in Oncology, Diagnostic and/or healthcare industry

•        Experience and a proven track record in healthcare related sales or with Health Plans, both in the private and government sector, including coverage policy, contracting, and pull-through

•        Experience with personalized medicine products or services

•        Demonstrated success with consistent achievement above defined goals & objectives

•        Knowledge and a proven track record in Oncology and Laboratory testing

•        History 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

•        Ability to take initiatives and act independently exercising strong business judgement within the scope of the role

•        Highly refined analytical and communication skills and the ability to work effectively both independently and in a team environment

•        Strong project management and negotiation skills

•        Understanding of HIPAA and the importance of patient data privacy

•        Commitment to reflect FMI’s values: Patients, Collaboration, Innovation, and Passion

 

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)

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.