Summary of Major Responsibilities
The Market Access Manager drives medical policy coverage initiatives, and contracting strategies within assigned regional managed care organization(s), and employer groups (employee benefit plans). Calls on managed care organizations developing coverage policy; provides technical and administrative product information and responds to requests for proposals. Travel is required at least 70% within region and at requested times, outside of incumbent's region to provide national support. Able 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.
Essential Duties and Responsibilities
Contract with major insurance companies and group payer organizations. 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.
Develop and implement strategies that lead to successful acceptance of Exact Sciences testing into payer medical policy guidelines.
Maximize reimbursement by negotiating the highest possible reimbursement rates.
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.
Initiate and develop relationships, track history and progress.
Serve as the principal contact with the payers, employers and providers in development and review of proposed agreements within assigned territory.
Prepare responses to Request for Proposals (RFP).
Assist field representatives with reimbursement challenges.
Attend conferences and physician meetings.
Support and comply with the company's Quality Management System policies and procedures.
Regular and reliable attendance.
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.
This is a field based role. Ability to travel approximately 70% of working time within region and some time outside of region for national or regional meetings.
Bachelor's degree in business, marketing or related field.
5+ years of experience in any of the following areas: contracting and coverage with large national payers, medical group contracting, sales leadership in biotech, device or diagnostic laboratory companies, or extensive experience working in health plan contracting, coverage or case management.
Extensive knowledge of reimbursement programs in pharma, lab, biotech, and/or device.
Candidate needs to reside in assigned geography.
Authorization to work in the United States without sponsorship.
Possession of a valid driver's license, no more than two moving violations in the past 36 months, and no unresolved license revocation or suspension issues.
Maintenance of sufficient driver's insurance to satisfy any applicable state or local requirements and at least $250,000 per person and $500,000 per accident in coverage.
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.
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.
Proven, effective time management, expense reporting, prioritization and delegation skills.
Effective English communication skills, both written and verbal.
Outstanding influencing, interpersonal and networking skills to drive successful relationship building.
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.
Strong presentation skills and the ability to speak confidently to all levels of an organization required.
#LI - CJ1
We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to age, color, creed, disability, gender identity, national origin, protected veteran status, race, religion, sex, sexual orientation, and any other status protected by applicable local, state or federal law. Applicable portions of the Company's affirmative action program are available to any applicant or employee for inspection upon request.