Senior Manager, Payer Access & Reimbursement

Job Description

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.

This is a Remote opportunity. 

Pay Range: $130,000 - $155,000/ year, 15% Annual Incentive Plan/Bonus

Salary offers are based on a wide range of factors including relevant skills, training, experience, education, and, where applicable, certifications obtained. Market and organizational factors are also considered. Successful candidates may be eligible to receive annual performance bonus compensation.

Benefits Information:

We are proud to offer best-in-class benefits and programs to support employees and their families in living healthy, happy lives. Our pay and benefit plans have been designed to promote employee health in all respects – physical, financial, and developmental. Depending on whether it is a part-time or full-time position, some of the benefits offered may include:

· Medical/Prescription Drugs

· Dental

· Vision

· Flexible Spending Accounts (FSAs)

· Supplemental Health Plans

· 401(k) Plan – Company match dollar-for-dollar up to 5%

· Employee Stock Purchase Plan (ESPP)

· Supplemental Life Insurance

· Dependent Life Insurance

· Short- and Long-Term Disability buy-up

· Blueprint for Wellness

· Emotional Well-Being Resources

· Educational Assistance

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.

Qualifications:

Required Work Experience: 

• 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 

Preferred Work Experience: 

• 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

Physical and Mental Requirements: 

• Ability to execute concurrent projects.
• Adaptable to abrupt changes in projects based on external influences/internal business needs.
• Strategic mindset
• Communication

Knowledge: 

• In-depth knowledge of medical terminology.
• Demonstrated understanding of the healthcare, health insurance, Medicare/Medicaid, and regulatory environments. 

Skills: 

• 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. 

Education

• Bachelor’s Degree Bachelor’s degree in a relevant discipline (e.g., life sciences, health/public policy) (Required)
• 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)

Work Requirements

• Travel Required up to 25%

62356

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While we appreciate and value our staffing partners, we do not accept unsolicited resumes from agencies. Quest will not be responsible for paying agency fees for any individual as to whom an agency has sent an unsolicited resume.

Equal Opportunity Employer: Race/Color/Sex/Sexual Orientation/Gender Identity/Religion/National Origin/Disability/Vets or any other legally protected status.