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Sr Manager, Payer Relations and Reimbursement

  • United States
  • Full Time

About the Job

The Senior Manager, Payer Relations and Reimbursement functions in a strategic, highly visible leadership position responsible for the identification, development, and management of strategic relationships with key payer customers with a focus on, Medical Groups/IPA's in California, key Managed Medicaid's and other payer accounts in California or other states as assigned that allow access and reimbursement for FMI testing. This individual is responsible for coverage pull through 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 targets; assist with payer related coverage pull through; negotiate, secure, and manage pull through of new and existing contracts with appropriate IPA's/Medical Groups, managed Medicaid and other key account that will help with company revenue and volume goals.
  • Establish a strong working relationship with payer customers and meet with customers regularly to discuss value of oncology products, partnerships, coverage utilization management, and INN contracting.
  • Demonstrate ability to secure INN contracts with customers.
  • Develop Account plans; conduct appropriate financial analyses and consider impact of applicable regulatory requirements. 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.
  • Work collaboratively with counterparts, including: payer policy partners, sales teams, medical teams, revenue and access, legal, and marketing personnel on strategic business development efforts to ensure coverage, access, and reimbursement of products.
  • Interact with senior management at key accounts 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, removing access barriers. Participate actively in the preparation and execution of regional field sales plans.
  • Provide feedback to appropriate company personnel regarding payer customer needs.
  • Keep abreast of the payer industry; regulatory, scientific, medical, operational, and incorporating into a strategic approach with payer customer.
  • 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 and payer ecosystem to provide education of products and ensure access to testing services including (but not limited to) KOL's, employers’ associations, like CCLA, local ASCO chapters, and patient advocacy groups.
  • Travel up to 35% of the time.
  • Other projects as assigned that influence coverage and reimbursement with payers.


Basic Qualifications

  • Bachelor’s Degree
  • 6+ years of experience within Health Plans and Payer/National Accounts and/or IDN’s Corporate Accounts in oncology and/or laboratory testing, or related experience

Preferred Qualifications

  • Advanced degree or healthcare certification(s)
  • 6+ years of experience in Oncology, Diagnostic and/or healthcare industry
  • A proven track record in healthcare related sales 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 account management and customer focus negotiation skills
  • Understanding of HIPAA and the importance of patient data privacy
  • Commitment to reflect FMI’s values: Patients, Collaboration, Innovation, and Passion



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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