Director, Market Access

Exagen Inc.•Carlsbad, CA

About The Position

Exagen is a patient-focused and discovery-driven life sciences company dedicated to transforming the care continuum for patients suffering from debilitating and chronic autoimmune diseases. Our goal is to enable rheumatologists to improve care for patients through the differential diagnosis, prognosis, and monitoring of complex autoimmune and autoimmune-related diseases, including lupus and rheumatoid arthritis. By leveraging our proprietary Cell-Bound Complement Activation Products, or CB-CAPs, technology, we help get to the real cause of a patient’s symptoms and guide their journey to improved health. The Director of Market Access is responsible for developing and implementing strategies and tactics aimed at driving favorable medical policy for Exagen’s testing solutions. This position requires cross-functional stake-holder engagement, including but not limited to executive leadership, Sales, Billing, Finance and Clinical Affairs. The ideal candidate will devise effective tactics to address payor objections, which may include refining clinical dossiers, engaging payor policy teams to address clinical evidence gaps and leveraging resources to initiate discussions with decision-makers at health plans.

Requirements

Bachelor's degree with 5 years related experience in the field of managed care marketing; training in the field of managed care, medical device, or diagnostic industry.
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
Ability to write reports, business correspondence, and procedure manuals.
Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentage.
Must be computer-literate.

Responsibilities

Develops and executes diagnostic strategy for obtaining positive medical policy, profitable contracts and maximum reimbursement for our products from managed care national and regional insurance accounts
Support and mentor Strategic Account Manager of health systems with the system’s health plan negotiations and contracting.
Collaborates with AVP of Clinical Affairs & Market Access, Sales, Billing and Financial Planning & Analysis to establish contract negotiation goals and strategies.
Manage relationships with key payors, and professional/industry societies related to Exagen’s testing solutions using a customer-centric mindset aimed at solving for the needs of internal and external stakeholders.
Collaborate with applicable internal stakeholders (Clinical Affairs, Billing, Market Access and Lab Operations) on the planning and development of LCD and associated Tech assessment submissions to applicable MACs for Exagen’s future R&D pipeline products
Serve as an internal educational resource, helping to cultivate an understanding of market access dynamics and the role that specific team members can take to affect policy change
Devise tactics and strategies aimed at overcoming payor objections to favorable medical policy, including but not limited to review/revisions to clinical dossiers, engagement with payor policy teams for feedback on clinical evidence gaps and leveraging resources to facilitate dialogue with key-decision makers at health plans.
Perform regular (quarterly) business reviews, including the evaluation of payor contracts for profitability and adherence to prescribed legal and reimbursement standards or directs this work by others.
Assess and communicate future marketplace/regulatory dynamics that may have an impact and provide proposed solutions regarding LCD coverage policies.
Organize and maintain a comprehensive schedule of policy review cycle dates by payor, ranked by potential business impact and ensure timely submission of clinical dossier materials for policy consideration.