Manager, Payer Access & Reimbursement

Quest Diagnostics•Secaucus, FL

4d•Remote

About The Position

The Manager supports Payer Access & Reimbursement activities as a member of a cross-functional team, oriented to Medical Affairs (MA) activities related to medical access, evidence generation, value proposition creation, and coverage in policy, all of which impact the reimbursement of Quest’s portfolio of tests. This individual proactively brings expertise in the reimbursement of laboratory medicine to build and execute key strategic initiatives and decision points. The Manager supports the coordination of internal strategic and procedural activities related to enhancing third-party coverage and reimbursement of Quest products with emphasis on oncology and genetics testing. This individual must possess medical knowledge with strong analytic, problem-solving, decision-making and presentation capabilities to facilitate the coverage and reimbursement process as it relates to stakeholders’ interests, while mitigating risk for the organization.

Requirements

6+ years experience between the following: Medical knowledge and healthcare experience (e.g., Laboratory, Clinical, Health Systems, Genetics, Molecular, Health Plan)
Payer policy/claims procedures (e.g., medical/reimbursement policy, billing and coding)
In-depth knowledge of medical terminology and medical conditions
Demonstrated understanding of the healthcare, health insurance, Medicare/Medicaid, and regulatory environments.
Strong time management
Strong written and oral communication skills
Collaborative approach in cross-function team settings
Intermediate-advanced skills in using Microsoft™ Word, Excel, and PowerPoint software packages.
Intermediate-advanced skills in Smartsheet.
Basic knowledge employing and familiarity with AI platforms.
Bachelor’s degree in relevant discipline (e.g., Life Sciences, health/public policy, Laboratory Medicine) (Required)
Travel Required approximately 20%

Nice To Haves

8 years experience between the following: Clinical experience in hereditary cancer, oncology, and germline genetics
Payer policy/claims procedures (e.g., medical/reimbursement policy, billing and coding)
Laboratory medicine (e.g., Clinical Laboratory Scientist/Medical Technologist, cytotechnologist, microbiologist, molecular variant scientist, laboratory genetic counselor)

Responsibilities

Assist in the execution of Medical Affairs strategies aligned with business needs and the evolving external health system environment (private and government payers, regulatory environment) for optimal access, utilization, and reimbursement of Quest products.
Identify opportunities to improve coverage and reimbursement (C/R) for assigned Payer Access category in all phases (e.g., idea to market, lifecycle management).
Support the execution and/or inform strategies based on root causes of denials.
Evaluate coverage landscape and focus on clinical utility.
Leverage and coordinate internal/external stakeholders and resources to identify and address C/R opportunities.
Collaborate with cross-functional teams (e.g., other MA teams, Clinical Discipline Specialists/Clinical Franchises, Health Plans, Billing, Coding/Compliance/Legal) to develop Payer Access strategies to optimally support business needs.
Collaborate with other internal Quest teams as needs arise.
Maintain knowledge of all assigned disease states, products, relevant changes in medical and reimbursement policies, and changes in payer procedures.
Ensure incorporation into the short and long-term business plans.
Performs other functions of the MA department as needed.