Market Access Operations Manager

Veracyte•San Diego, CA

1d•Hybrid

About The Position

The Market Access Operations Manager is responsible for the operational infrastructure that enables Market Access execution across Veracyte’s diagnostic testing portfolio. This includes payer credentialing and enrollment, state Medicaid participation, contract implementation, and maintaining the system of record for Market Access agreements and documentation. The role translates payer contracting and coverage strategies into accurate operational execution in partnership with Market Access, Reimbursement Operations (RCM), external consultants, Client Services, Finance, Legal, Compliance, Regulatory, and Commercial Operations teams. It reports to the Director, Market Access & Payer Relations. The position oversees payer and government enrollment, contract administration, operational documentation, compliance calendars, payer-related reimbursement issues, and the systems and vendors that support these activities. It also develops operational reporting and process improvements, including the use of automation and AI tools. The role is suited to someone with healthcare reimbursement operations knowledge, a proactive and solutions-oriented approach, and an interest in improving access to innovative diagnostic testing.

Requirements

Bachelor’s degree or equivalent combination of education and relevant experience.
At least 6–7 years of experience in healthcare reimbursement operations, payer credentialing, provider enrollment, managed care operations, revenue cycle, Market Access operations, or a related function.
Demonstrated experience managing payer enrollment across commercial and government payers, including hands-on multi-state Medicaid enrollment and revalidation.
Working knowledge of enrollment systems and requirements for facility and laboratory entities, including NPPES, PECOS, state Medicaid provider portals, and enrollment tracking platforms.
Demonstrated ownership of a recurring compliance calendar, such as revalidation, recredentialing, licensure renewal, or contract renewal, with a track record of preventing lapses.
Experience administering contracts, fee schedules, or reimbursement documentation as a system of record, including version control and access management.
Strong project management skills, including coordinating cross-functional initiatives involving reimbursement, billing, legal, compliance, finance, and commercial teams while managing multiple priorities, deadlines, and stakeholders.
Experience developing and maintaining operational documentation, workflows, and standard operating procedures.
Ability to manage sensitive personal and corporate information, including ownership and control disclosures, with professionalism, accuracy, and confidentiality.

Nice To Haves

Experience supporting molecular diagnostics, genomic testing, laboratory developed tests (LDTs), precision medicine, oncology diagnostics, or other specialty diagnostic products.
Experience enrolling an out-of-state laboratory in state Medicaid programs and navigating state-specific restrictions on out-of-state laboratory participation.
Experience with Medicaid managed care plan contracting and roster processes distinct from state fee-for-service enrollment.
Experience with credentialing and contracting in VA and DoD facilities.
Experience implementing or administering an enrollment tracking platform or contract lifecycle management system.
Certified Provider Credentialing Specialist (CPCS) or similar credentialing certification.
Familiarity with Medicare coverage, commercial payer operations, laboratory benefit managers, and diagnostic reimbursement pathways.
Experience with healthcare compliance, audit readiness, and credentialing governance processes.

Responsibilities

Lead payer credentialing, re-credentialing, enrollment, and network participation activities across commercial payers, Medicare contractors, state Medicaid programs and managed care plans, laboratory benefit managers, and other reimbursement stakeholders.
Own the enrollment lifecycle, including initial applications, revalidation, roster and demographic updates, and ongoing maintenance requirements.
Manage state-specific Medicaid enrollment requirements, including out-of-state laboratory enrollment where permitted, documentation and attestations, application fees, risk-level screening such as fingerprinting and site visits, and contracting with Medicaid managed care plans after state enrollment is active.
Manage federal government documentation, including SAM ID and associated opportunities, Federal Supply Schedule changes and applications, and documents related to SBA plans, within required timelines.
Coordinate ownership, control, and managing employee disclosures required for payer and government enrollment applications, working with Legal, Human Resources, Compliance, and executive leadership while safeguarding sensitive information.
Maintain accurate laboratory, facility, and organizational records across payer systems and enrollment platforms, including NPPES and PECOS demographic data, NPI and taxonomy assignments, PTAN alignment, W-9 and remittance addresses, and payer directory listings.
Partner with Regulatory and Quality to keep CLIA certification and state clinical laboratory licenses and permits current, and align enrollment activities with state licensure prerequisites.
Own the post-execution contract lifecycle, including effective and termination dates, renewal and notice windows, amendments, and escalation of approaching deadlines to contracting leads.
Establish and maintain the system of record for Market Access documentation, including executed agreements and amendments, payer medical policies and coverage determinations, payer correspondence, supporting evidence, and dossier materials.
Maintain version control, access permissions, and retention standards across document management, CRM, and CLM platforms.
Collaborate with RCM teams to identify and resolve enrollment-related claim issues, reimbursement delays, and payer operational challenges, including issues involving payer portals such as Availity.
Develop and maintain standard operating procedures, process documentation, and operational controls for enrollment, payer setup, contract administration, and reimbursement operations.
Support payer audits, credentialing reviews, and compliance requests.
Select, implement, and administer enrollment tracking and contract repository systems, and manage credentialing vendors, external consultants, and third-party partners.
Develop dashboards, reporting, and KPIs measuring operational performance, including enrollment cycle time by payer type, target Medicaid lives with active enrollment, on-time revalidation rate, denial dollars attributable to enrollment or configuration defects, and contract record completeness.
Evaluate workflows, identify operational efficiency opportunities, and execute process improvements using automation and AI tools.
Manage group inboxes for payer correspondence and contracting communications.