Director, Payer Policy Job at NeoGenomics Laboratories

Market Director Payer Strategy

This is a remote position. Location preferred for candidate is in the state of T...

Location

United States , Englewood

Salary:

60.24 - 79.81 USD / Hour

American Nursing Care

Expiration Date

Until further notice

Requirements

Bachelor’s Degree – equivalent education and experience in payer strategy, managed care or provider network senior level role may be considered in lieu of degree
Minimum of five (5) years of experience in healthcare or managed care industry
Minimum of four (4) years of leadership experience
experience with healthcare payers and plan in the Texas market

Job Responsibility

Responsible for managed care policies, goals and objectives related to contract language and reimbursement, negotiation strategy, and payer relationships
Collects and communicates Market-level insight and strategic knowledge to/from the PSR National Payer teams, the PSR Growth and Innovation team, and other key departments
Secures optimal fee for service and value-based reimbursement
Protects the interests of the owned and/or affiliated hospitals/ancillaries/professional provider entities in contract negotiations
Strengthens CommonSpirit Health’s relationships with payers
Participates in the development of Market strategy, relationships, and contracts with local and national payers
Gathers information and guidance from Region PSR VP, ministry leaders, internal stakeholders, and financial analysis
Establishes, builds, and maintains positive, strategic interactions and relationships with payers, employers, providers, and leaders
Maintains relationships with National Payer contacts with offices in the Market
Maintains appropriate Center of Excellence (COE) Designations

What we offer

medical
prescription drug
dental
vision plans
life insurance
paid time off (full-time benefit eligible team members may receive a minimum of 14 paid time off days, including holidays annually)
tuition reimbursement
retirement plan benefit(s) including, but not limited to, 401(k), 403(b), and other defined benefits offerings

Fulltime

Region Director Payer Analytics Economics-Mountain

As our Division Director, Payer Analytics & Economics, you will be accountable f...

Location

United States , Englewood

Salary:

66.26 - 98.56 USD / Hour

American Nursing Care

Expiration Date

Until further notice

Requirements

Bachelors Other Business Administration, Accounting, Finance, Healthcare or related field
Minimum of eight (8) years of experience in contributing to profitability through detailed financial analysis and efficient delivery of data management strategies supporting contract analysis, trend management, budgeting, forecasting, strategic planning, and healthcare operations
Minimum of three (3) years of healthcare or financial leadership experience
Managed Care and Healthcare experience strongly preferred

Job Responsibility

Manage the labor and operations of the Division Payer Analytics & Economics team(s) including the hiring, orienting, developing and managing of staff
Oversee quality control and quality assurance of Payer Analytics & Economics analytics deliverables and financial models to support the negotiation and implementation of appropriate reimbursement rates associated language, between physicians/hospitals and payers/networks for managed care contracting initiatives
Review and accurately interpret contract terms, including payer policies and procedures to appropriately contract performance and influence strategic pricing strategies
Monitor contract financial performance. Analyze and publish managed care performance statements and determine profitability
Provide training and oversight of the modeling of proposed/existing payer contracts negotiated by payer strategy and operations, including expected and actual revenues/volumes, past performance, proposed contract language and regulatory changes
Oversee and prepare complex service line reimbursement analyses and financial performance analyses. Develop methods and models (involving multiple variables and assumptions) to identify the implications/ramifications/results of a wide variety of new/revised strategies, approaches, provisions, parameters and rate structures aimed at establishing appropriate reimbursement levels. Prepare and effectively present results to senior leadership, and other key stakeholders, for review and decision making activities

What we offer

medical, prescription drug, dental, vision plans, life insurance, paid time off, tuition reimbursement, retirement plan benefit(s) including, but not limited to, 401(k), 403(b), and other defined benefits offerings

Fulltime

Principal Epic Payer Platform Director

The Principal Epic Payer Platform Director, serves as a subject-matter expert wh...

Location

United States , Madison

Salary:

153000.00 - 259000.00 USD / Year

Exact Sciences

Expiration Date

Until further notice

Requirements

Bachelor’s Degree or equivalent in a relevant field that aligns with the essential duties
8+ years of U.S. health care industry experience
3+ years of experience working on Epic Payer Platform related initiatives for health care providers or health plans
Advanced understanding of Epic’s Care Everywhere and interoperability modules and tools
Working knowledge of FHIR, HL7, X12, and/or CDA standards, and familiarity with Epic data structures, including Clarity and Caboodle
Strong understanding of HIPAA, HITECH, and data privacy/security requirements
Strong negotiation and influence skills for driving adoption of interoperability solutions
Proficiency in Microsoft Office programs, such as Word, Excel, PowerPoint, Outlook, OneNote, and SharePoint
Demonstrated ability to perform the essential duties of the position with or without accommodation
Legal authorization to work in the country of employment without current or future sponsorship

Job Responsibility

Lead enterprise core team(s) responsible for implementing Epic Payer Platform solutions and strategies with Exact Sciences’ health plan and system customers
Maintain the enterprise’s strategic roadmap for using Epic’s Payer Platform and other Epic modules to support interoperability and data exchange with health plan and system customers
Research and stay up to date on health care IT industry trends, use cases, and benchmarks to inform enterprise priorities
Present to and educate cross-functional groups on these trends
Support business case proposals and opportunity assessments for the Market Access team to leverage in planning and health plan negotiations
Serve as a decision-maker on which internal or external technologies should be adopted or developed to drive population health initiatives
Partner with Epic and other external technology vendors to shape integration models that scale care coordination, digital result delivery, and data exchange
Participate in a cross-functional strategic core team(s) focused on identifying long-term market growth and technology investment opportunities
Represent Market Access in collaborations with IT, Compliance, Product, and external partners to ensure alignment and strategic execution
Uphold company mission and values through accountability, innovation, integrity, quality, and teamwork

What we offer

paid time off (including days for vacation, holidays, volunteering, and personal time)
paid leave for parents and caregivers
a retirement savings plan
wellness support
health benefits including medical, prescription drug, dental, and vision coverage
bonus eligible

Fulltime

Director - Market Access Payer & Provider Strategic Contract Analytics

At GSK, we are focused on uniting science, technology, and talent to get ahead o...

Location

United States , Philadelphia; Durham

Salary:

Not provided

GSK

Expiration Date

Until further notice

Requirements

Bachelor's degree in quantitative field (e.g., Statistics, Economics, Data Science, Mathematics, Engineering, or related)
7+ years of experience in US Market Access analytics, including payer/PBM/provider contracting analytics
Demonstrated experience with advanced analytics, predictive modeling, or data science applications in a Market Access setting
Understanding of payer and provider contracting dynamics, including formulary access, reimbursement and utilization management
Experience working with pharmacy and medical benefit data, including claims and lives data
Proven ability to influence senior stakeholders and translate complex analytics into business strategy
Experience managing cross-functional initiatives and external vendors

Job Responsibility

Lead the development and evolution of advanced analytics capabilities that support payer and provider contracting strategies across pharmacy and medical benefit products
Build and apply predictive models, simulation frameworks, and scenario-based analyses to evaluate pricing, access, and reimbursement strategies, and quantify their impact on patient access, utilization, and market performance
Partner closely with Market Access Strategy and Strategic Accounts teams to inform negotiation approaches and shape pre-deal strategy
Establish and oversee key performance indicators and measurement frameworks that enable robust evaluation of contract performance, delivering ongoing performance insights and executive-level reporting that highlight risks, opportunities, and areas for optimization
Translate post-deal analytics into actionable recommendations that improve contracting effectiveness and business outcomes
Drive innovation in data integration by leveraging real-world data sources, including claims and lives data, formulary information, and external datasets, while evaluating and implementing AI-enabled tools and automation solutions to improve analytical efficiency and scalability
Collaborate cross-functionally with teams across Market Access, Finance, and Commercial Insights to align analytical outputs with business needs, translating complex business questions into clear analytical requirements and ensuring effective execution across internal teams and external partners
Manage relationships with analytics vendors and data providers to deliver high-quality, innovative solutions
Monitor and assess the impact of healthcare policy changes, legislation, and evolving payer and provider dynamics on access and contracting strategy, and provide analytical support for medical benefit strategies, including provider reimbursement and buy-and-bill models
Serve as a thought leader by bringing external perspectives and industry best practices to advance Market Access analytics capabilities

What we offer

Competitive base salary
Annual bonus based on company performance
Flexible working options available for most roles
Learning and career development
Access to healthcare & wellbeing programmes
Employee recognition programmes

Fulltime

Health Policy & Reimbursement Executive Director

In this vital role the Health Policy & Reimbursement Executive Director will lea...

Location

United States , Washington D.C.

Salary:

281425.00 - 325550.00 USD / Year

Amgen

Expiration Date

Until further notice

Requirements

Doctorate degree & 6 years of health policy or reimbursement experience
Master’s degree & 10 years of health policy or reimbursement experience
Bachelor’s degree & 12 years of health policy or reimbursement experience
6 years of managerial experience directly managing people and/or leadership experience leading teams, projects, programs or directing the allocation of resources

Job Responsibility

Lead development and implementation of reimbursement strategies for federal (US) payer issues across multiple therapeutic areas and the company’s biosimilar portfolio
Work cross-functionally to help identify and resolve barriers to entry for pipeline products/ therapies and provide broad reimbursement-related advice for inline products, including mitigation strategies in response to proposals that would negatively affect access of Amgen therapies for patients
Manage broader health policy efforts including reviewing and analyzing complex policy proposals including regulatory proposals and legislative text, and promptly and concisely communicating impact of these proposals to key internal audiences (government affairs, commercial, regulatory, clinical, and senior executives)
Collaborate with government affairs staff to ensure alignment of strategy, talking points and messaging to constituents (elected officials/leaders, agencies, third parties, etc.)
Play a key role in health policy engagement with major trade associations on corporate policy priorities which include Amgen specific priorities as well as industry-wide priorities including, but not limited to, Federal drug pricing policy
Conduct research and integrate clinical, market and payer data to inform engagement on reimbursement objectives
Regularly update via written and oral communications to senior executives and other key partners on various reimbursement and US health policy topics

What we offer

Comprehensive employee benefits package, including a Retirement and Savings Plan with generous company contributions, group medical, dental and vision coverage, life and disability insurance, and flexible spending accounts
A discretionary annual bonus program, or for field sales representatives, a sales-based incentive plan
Stock-based long-term incentives
Award-winning time-off plans and bi-annual company-wide shutdowns
Flexible work models, including remote work arrangements, where possible

Fulltime

Associate Director Access & Reimbursement

The Associate Director of Access & Reimbursement is responsible for leading the ...

Location

United States

Salary:

210000.00 - 250000.00 USD / Year

The Muse

Expiration Date

Until further notice

Requirements

Bachelor's Degree required, in Business, Health Policy, or Life Sciences preferred
AAPC coding courses / or equivalent a plus
10+ years of relevant experience in the pharmaceutical healthcare sector
5+ years in the vaccine payer space
Experience in working with US payers
Experience in billing /coding for both buy & bill products (medical) & pharmacy billing PBM (drug benefit) (strongly preferred)
Strong leadership skills and demonstrated ability to lead cross functionally
Deep understanding of Commercial, Medicare, and Medicaid and how it pertains to Influenza vaccine coverage and payment
A proven track record of successful account management and executing national strategies
Demonstrated results in the area of GPO, health system, retail, wholesaler/distributor with vaccine reimbursement vs general Pharma

Job Responsibility

Enact key strategic initiatives to help facilitate CSL Seqirus to achieve / exceed specific sales volume, revenue, and profitability targets
Leads CSL Seqirus interactions with all payers. Fosters and develops multi-level and senior relationships to create a foundation for developing a pathway to effectively communicate CSL Seqirus story
Analyze payer access and reimbursement (medical & drug) landscape for near-term and longer-term objectives. Provide insights on the analysis to create change in the organization. Using pareto mentality develops strategies and tactics to ensure positive change. Develops a customized approach for each payer to most effectively influence change. Reports timely feedback regarding account interactions and next steps
With relationship depth and breadth of customer interaction at various (senior management clinical / financial / operational) levels of the customer's organization, builds and maintains relationships with key individuals to enable market access of CSL Seqirus vaccines, developing a favorable environment for pull-through at the national, regional, and local provider levels. Develops and sponsors key programs which address customer needs and enhances the customer value perception of CSL Seqirus
Convinces internal and external stakeholders about the value of the CSL Seqirus Customer Experience vision
Acts as the voice of the customer with internal stakeholders to build Seqirus' acumen on customer challenges
Develops and executes business solutions at customers that help enhance CSL Seqirus' partnership within CSL Seqirus primary channels
Provides expertise to the organization as an SME in regards to reimbursement at national and regional level and ensures CSL Seqirus products have market access at all National and select Regional health plans and PBMs. Has effective strategies in place when there are coverage issues by being able to connect with key payer decision makers immediately to fix coverage issues
Works with internal and external stakeholders to enhance CSL Seqirus position in the market
Identifies areas of opportunity for CSL Seqirus growth and directs the organization to implement in an efficient manner

What we offer

Health Insurance
Dental Insurance
Vision Insurance
Life Insurance
Short-Term Disability
Long-Term Disability
FSA
HSA
Mental Health Benefits
Adoption Leave

Fulltime

Revenue Cycle Director

Location

United States , Salina

Salary:

Not provided

Central Care Cancer Center

Expiration Date

Until further notice

Requirements

Bachelor's Degree from four-year college or technical school
Minimum 3-5 year's related experience and/or training
Medical billing and contract experience required
Oversee collection processes
Conducts performance evaluations
Excellent management and supervisory skills
Excellent analytical and organizational skills
Excellent written and verbal communication skills
High degree of sound independent judgment, initiative, and high standard of ethics

Job Responsibility

Drive operating efficiency and program development initiatives to enhance revenue generation capabilities
Develop and implement strategies to enhance revenue generation and minimize revenue loss across all clinic locations
Ensure compliance with all applicable billing, coding, and regulatory standards related to oncology services
Oversee billing systems and claims processes, to ensure accurate and timely reimbursements
Streamline the patient financial experience and identify opportunities to improve patient collections
Collaborate with financial team to explain variances and determine mitigating actions
Partner with executives and directors to identify and implement process improvements that enhance revenue generation and operational efficiency
Serve as a liaison between receptionists and financial counselors, to improve communication and workflow efficiency
Maintain in-depth knowledge of oncology-specific billing, coding, and reimbursement policies, including in-office infusions and oral medications
Stay current on healthcare regulations, payer policies, and revenue cycle best practices, ensuring compliance and adaptability

Fulltime

Director of Government Affairs

Influence policy, build partnerships, and advance better healthcare for patients...

Location

Germany , Berlin

Salary:

Not provided

Proclinical

Expiration Date

Until further notice

Requirements

Strong understanding of healthcare policy developments, local regulatory and HTA processes, and an established network of government and policy stakeholders
University degree required
Fluency in German and English
Strategic thinking, problem-solving, and analytical skills
Ability to collaborate effectively across organizational structures and with external partners
Excellent writing and editing skills for policy and business documents
Strong project management and organizational abilities to handle multiple priorities
Confident presentation skills for internal and external audiences
Willingness to travel regularly, including approximately 50% travel activity, with frequent visits to Munich

Job Responsibility

Develop and implement a comprehensive government affairs strategy aligned with business objectives
Act as a strategic partner to the country leadership team and contribute to the extended German Leadership Team
Lead engagement efforts with government officials on legislation, regulation, pricing, reimbursement, and policy initiatives
Create and execute flagship initiatives to support a favorable healthcare environment and improve patient access
Monitor healthcare developments impacting innovative medicines and devise risk mitigation strategies
Manage local political consultants and coordinate related projects
Collaborate with internal teams, including market access, regulatory, legal, compliance, patient advocacy, commercial, and medical functions, to align plans and activities
Engage with policymakers, payers, trade associations, and other stakeholders to shape healthcare policies
Conduct briefings, meetings, and forums to provide updates on healthcare policy issues
Respond to public consultations and develop compelling policy arguments and materials

Select Country

Director, Payer Policy

Job Description

Job Responsibility

Requirements

Nice to have

What we offer

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