Senior Manager, Payer Access & Reimbursement

Quest Diagnostics•Tampa, FL

18h•Remote

About The Position

The Senior 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 Senior Manager is instrumental in the coordination of activities related to external engagement with health plans, specialty societies, coalitions, and others where required to enhance coverage and reimbursement or improve the reputation of Quest Diagnostics with the professional and payer communities. This individual must possess strong leadership, problem solving, and presentation capabilities to help facilitate the decision-making process as it relates to stakeholders’ interests, while mitigating risk for the organization.

Requirements

8 years’ experience between the following: Laboratory medicine (e.g., Medical Technologist, cytotechnologist, microbiologist, molecular variant scientist, laboratory genetic counselor) Payer policy/claims procedures (e.g., medical/reimbursement policy, billing and coding) Clinical practice
In-depth knowledge of medical terminology.
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-functional team settings
Intermediate-advanced skills in using Microsoft™ Word, Excel, and PowerPoint software packages.
Bachelor’s Degree in a relevant discipline (e.g., life sciences, health/public policy) (Required)

Nice To Haves

10 years’ experience between at least two of the following: Laboratory medicine (e.g., cytotechnologist, microbiologist, molecular variant scientist, laboratory genetic counselor) Payer policy/claims procedures (e.g., medical/reimbursement policy, billing and coding) Clinical practice
Master’s Degree Advanced degree (e.g., Master’s or doctorate) in a relevant discipline (e.g., life sciences, health/public policy, genetic counseling) (Preferred)

Responsibilities

Assist in the development of MA 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 and harness opportunities to improve coverage and reimbursement (C/R) for assigned Payer Access category in all phases (e.g., idea to market, lifecycle management).
Execute 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 Franchises, Health Plans, Billing, Coding/Compliance/Legal) to develop Payer Access strategies to optimally support business needs.
In conjunction with Payer Access leadership and cross-functional teams, support efforts to develop medical value proposition for marketed tests and pipeline assets.
Collaborate with other internal Quest teams as needs arise.
Execute project responsibilities for some aspects of the evidence-based medical documentation development and communication.
Identify and track progress of Annual Operating Plan (AOP) activities including appropriate metrics and reporting platforms.
Participate in the drafting and revision of written materials (e.g., policy response letters, slide decks) for external distribution.
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.
Educate the Clinical Franchise, Commercial, Medical, Legal/Compliance, and Research and Development organizations about the evolving healthcare payor environment, the key external stakeholders, and their evidence needs.
Lead and contribute to establishing processes that support successful development and communication of reimbursement-based value proposition for Quest Diagnostics offerings.
Support and lead the strategic development and participation in health policy efforts.
Understand and participate in the emerging dialogue on clinical evidence needed to support/expand coverage and reimbursement for diagnostic tests in assigned Payer Access category.
Performs other functions of the MA department as needed.