Foundation Medicine is seeking candidates for Director, Payer Relations & Reimbursement to join our team. The Director, Payer Relations and Reimbursement will function in a strategic, highly visible leadership position responsible for the identification, development and management of strategic relationships with regional payers and organizations that influence payer decision-making. With minimal supervision, this person will be responsible for achieving revenue, profitability and other goals as an individual contributor.
Assists the VP, Regional Payer Relations & Reimbursement and Regional Sales Managers to set strategic vision for assigned payer targets, assist with payer related policy issues, negotiate, secure, and manage pull through from regional contracts with appropriate payer accounts , including, but not limited to, managed care organizations (MCOs), Accountable Care Organizations (ACOs), specialty pharmacy companies, health systems, reference laboratories, oncology pathways companies, disease management companies, insurance companies and potentially, self-insured employers, military or other government payers.
Develops regional contracting plans and forecasts, conducts appropriate financial analyses and considers impacts of applicable regulatory requirements.
Leads teams of sales/technical/medical/marketing personnel on larger regional and national payer contracting and other strategic business development efforts.
Involved with senior management and/or multiple decision-makers to conclude a positive coverage policy and/or contract negotiation.
Serves as liaison between payer customers and company personnel on administrative matters.
Co-leads commercialization strategy with the Regional Sales Managers and SVP of Sales and participates actively in the preparation and execution of regional field sales plans.
Works in collaboration with Field Sales to aid in training and co-promoting FMI diagnostics in their assigned accounts.
Generates forecasts to determine projected return on closed contracts, including estimates of anticipated orders to management, as well as estimates of market potential by product/service/geographic area.
Provides feedback to appropriate company personnel regarding payer customer response to contract offerings and service.
Arranges for payer customer visits to labs or to company-sponsored educational briefings.
Keeps abreast of payer industry, regulatory, scientific, medical, operational and marketing plans and incorporates into strategic sales approach.
May represent company at trade shows, scientific or other meetings.
Analyzes regional payer customers’ near-term and longer-range requirements and promotes consideration of new or refined company services to meet such requirements.
Assists in the development and supports revenue enhancement initiatives to increase return on regional and national account contracts.
Responsible for the development and maintenance of positive working relationships with key influencing organizations such as regional and national payer trade associations, Specialty Pharmacy, Professional Society, Disease Management, Employers/Brokers and other higher level strategic relationships.
Approximately 30-50% field travel required.
Knowledge and a proven track record in cancer testing, or specialty pharmaceutical oncology product markets is essential (at least one market in oncology).
Experience and a proven track record with regional managed care plan coverage policy, contracting and pull-through is also essential.
Demonstrated relationships with key payer decision-makers and influencers is essential.
Demonstrated success with consistent achievement above defined sales goals & objectives.
A proven track record of success with special projects and very difficult selling scenarios including, but not limited to, adoption of disruptive innovation or transformative products or services, reversals of negative coverage policy, reversals of threatened contract terminations, consistent increases in negotiated rates and contracting for previously excluded services.
Experience and a proven track record with personalized medicine products or services is a plus.
Experience with government payers, ACO contracting, coverage policy, oncology specialty pharmacy, employer group contracting, health system contracting, GPO contracting, and/or health economics is a plus.
Demonstrated ability to work effectively with cross-functional teams in a fast-paced, multi-dimensional organization.
Strong project management, communication and financial analysis skills are required.
Education or Experience:
Bachelor degree in a Scientific or Business discipline (minimum), advanced degree or healthcare certification(s) a plus.
Extensive experience (10+) in Diagnostic and/or healthcare industry.
Requires limited technical training and training in consultative sales approaches.