Position SummaryThe Director of Market Access drives medical policy coverage initiatives and contracting strategies within assigned regional managed care organization(s), and employer groups (employee benefit plans). Responsible for obtaining positive payer coverage policies, securing in-network contracting and maximizing reimbursement while minimizing access barriers for patients and providers. Travel is required at least within region and at requested times, outside of incumbent's region to provide national support. Ability to manage complex contracting documents ensuring business needs are met within the agreements and make recommendations on legal review and pull-through initiatives coordinated with marketing and sales teams.
Job Responsibilities- Contract and be an in-network provider for insurance companies and group payer organizations within region
- Manage complex contract negotiation and work with cross functional departments to bring the contracting process to closure
- Manage existing relationships with existing contracted insurance companies
- Initiate and develop new relationships to sign contracts with targeted payers, track meetings and progress
- Develop and implement strategies that lead to successful acceptance of Caris Life Sciences testing into payer medical policy guidelines
- Maximize reimbursement by negotiating the highest possible reimbursement rates and holding payers to contract terms
- Stay up to date on trends in the managed care market and develop strategy with senior management to address the changes and maintain acceptable reimbursement rates
- Prepare, coordinate, and manage contract negotiation process
- Identify and evaluate opportunities and financial terms for MCOs, GPOs, IPAs, and other healthcare systems
- Assess potential legal risk in the context of contract provisions. Prepare letters of agreement and key contract provisions
- Identify and target specific market segments for development, including key payers, employers, or other managed care organizations
- Serve as the principal contact with assigned payers, employers and providers and review proposed agreements within assigned territory
- Prepare responses to Request for Proposals (RFP)
- This role manages multiple project deadlines while working collaboratively with a team
- Directly interact with clients and other stakeholders, either in person, via teleconference or email
- Develop advocacy from clinicians, society, and patient sources, and ensure effective communication to key stakeholders, including medical and trade associations
- Ensure compliance with relevant regulations and standards for product access and market entry
- Assist field representatives with reimbursement challenges
- Attend conferences and physician meetings
- Uphold company mission and values through accountability, innovation, integrity, quality, and teamwork
Required Qualifications- Bachelor's Degree in Business, Marketing, Science, or related field
- 5+ years of experience in any of the following areas: contracting and coverage with large national payers, medical group contracting, sales, sales leadership in biotech, device or diagnostic laboratory companies, or extensive experience working in health plan contracting, coverage or case management
- 5+ years of reimbursement programs in pharma, lab, biotech, and/or devices
- Possession of a valid driver's license
- Demonstrated ability to perform the essential duties of the position with or without accommodation
- Authorization to work in the United States without sponsorship
- Strong presentation skills and the ability to speak confidently to all levels of an organization require
- Ability to develop a value proposition and effective business case that will influence medical policy
- Ability to present clinical data, scientific findings, and complex information in a persuasive manner to a variety of audiences
- Effective English communication skills, both written and verbal
- Outstanding influencing, interpersonal and networking skills to drive successful relationship building
- Strong knowledge of Microsoft Office Suite (PowerPoint and Word)
Preferred Qualifications- Proven success at negotiating contracts with payers that yield reimbursement at desired ASP
- Reimbursement contracting and coverage experience, preferably in molecular diagnostics or life sciences
- Able to work independently with little direction, capacity to research and stay current on managed care and healthcare industry trends
- Possess a solid understanding of the molecular diagnostic testing market: products, companies, and technology
- Best demonstrated track record of developing and managing complex negotiations with multiple decision makers
- Outstanding problem solving, project and program management skills
- Proven, effective time management, expense reporting, prioritization, and delegation skills
- Effective presentation skills; able to present ideas to customers in a way that produces understanding and impact
- Existing relationships with individuals at insurance companies and group payer organizations
Training- All job-specific, safety, and compliance training will be assigned based on the job functions associated with this role
Physical Demands- Ability to lift up to 10 pounds for approximately 10% of a typical working day
- Ability to work seated for approximately 80% of a typical working day Ability to work standing for approximately 20% of a typical working day
- Ability to work in front of a computer screen and/or perform typing for approximately 80% of a typical working day
- Ability to comply with any applicable personal protective equipment requirements
- Ability to travel approximately 50% of working time within region and limited time outside of region for national or regional meetings
Other- Participation in an on-call rotation for IAM support may be required
- Other duties as assigned
Annual Hiring Range$170,000 - $190,000Actual compensation offer to candidate may vary from posted hiring range based upon geographic location, work experience, education, and/or skill level. The pay ratio between base pay and target incentive (if applicable) will be finalized at offer.
Description of Benefits- Highly competitive and inclusive medical, dental and vision coverage options
- Health Savings Account for medical expenses and dependent care expenses
- Flexible Spending Account to pay for certain out-of-pocket expenses
- Paid time off, including: vacation, sick time and holidays
- 401k match and Financial Planning tools
- LTD and STD insurance coverages, as well as voluntary benefit options
- Employee Assistance Program
- Pet Insurance
- Legal Assistance
- Tuition Assistance
Conditions of Employment: Individual must successfully complete pre-employment process, which includes criminal background check, drug screening, credit check ( applicable for certain positions) and reference verification.This job description reflects management's assignment of essential functions. Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.Caris Life Sciences is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.