Position Summary:
Baylor Genetics (BG) is currently expanding its Market Access team. BG seeks to secure Lab Provider in-network contracts and achieve medical coverage, access and reimbursement for clinical diagnostic genetic testing within the Medicaid Channel of Payer segments to serve Medicaid insured members within a complex, ever-changing Payer environment.The Director, Channel Strategy - Medicaid is a field-based position responsible for achieving and maintaining Medicaid FFS and Medicaid Managed Care medical coverage policies, garnering access, and in-network contract procurement for Baylor Genetics clinical diagnostic laboratory genetic tests within a given geography.
Additional responsibilities include serving as the subject matter expert on government policy legislative intel on Payer market access issues related to state and federal legislation impact on expanding coverage and reimbursement for medical diagnostic genetic testing.As a key member on the Market Access team, the Director, Channel Strategy - Medicaid develops and manages relationships within assigned Medicaid FFS and Medicaid Managed Care Payer accounts, implements Medicaid account strategies, drives the expansion of Provider in-network contracts and spearheads government policy projects aligned to the overall Market Access growth strategy to shape medical policy decisions.
DUTIES AND RESPONSIBILITIES:
· Achieve positive medical coverage policy decisions for BG tests by engaging with targeted Payer coverage policy decision stakeholders with Medicaid FFS agencies, Medicaid Managed Care (MMC) and Medicaid Exchange Payer accounts.· Adhering to specific Payer account engagement processes to implement Market Access strategies that address unmet needs; ultimately achieving product access for the Medicaid targeted population.· Drive the in-network contracting strategy within assigned Medicaid Managed Care (MMC) and Medicaid Exchange Payer accounts to expand and obtain new in-network Provider Lab contracts.· Understands the impact of Medicaid state credentialing on Provider lab contract delivery & tracking.· Hands-on experience working with government relations, advocacy, stakeholder engagement, or piloted Legislative issue management campaigns concerning clinical laboratory access challenges.· Maintain strong understanding of Part B Medical policy content, biomarker state legislation mandates, and industry association evidence-based guidelines impacting coverage and access.· An ability to quickly grasp legislative state policies and political issues impacting clinical laboratory coverage and reimbursement.
(e.g. Any Willing Provider Legislation, etc.).· Own the business by creating and seizing opportunities to proactively identify and clear access barriers to deliver results.· Maintain Medicaid-related key stakeholder relationships to generate potential solutions in preparation for future product launches.· Collaborates with BG cross-functional teams – Credentialing, Medical Science Liaisons, Legal, Revenue Cycle Management, Sales, and Market Access team members to offer insight, identify gaps, and implement account-specific executional strategic and tactical planning that strengthens business opportunities aligned with BG strategic priorities.· Synthesize Payer account insights and Payer market intelligence on a frequent cadence to inform and align.Meet or exceed targeted Payer account strategic objectives and metric achievement.· Conducts routine account business reviews to inform Market Access leadership on relevant updates and/or barriers to access.· Demonstrates resourcefulness and an open-minded thinking to formulate approaches to expand coverage and reimbursement.· Uphold company mission and values; ensure compliance with all company policies and guidelines.· Adheres to Code of Conduct as outlined in the Baylor Genetics Compliance Program.· Leverage Payer deliverables and enlist Market Access Senior Management support to address barriers to care, Payer needs, and manage anticipated threats to product access.· Performs other job-related duties as assigned.Additional Responsibilities:· Perform ethically through ambiguity in a government-regulated environment· Communicate with Integrity and Emotional intelligence· Ability to pivot in an ever-changing Payer environment
QUALIFICATIONS:
Education:o Bachelor's Degree requiredExperience:o 8+ years of direct experience in U.S. Payer account management (medical benefit) requiredo
Demonstrated success in achieving positive and/or retracting negative coverage policy decisions with Medicaid FFS/Medicaid Managed Care Payers required.
o Experience with molecular diagnostics (MolDx), or genetics is a plus.o Biopharma Payer account management (medical benefit) experience is welcomed.o Knowledge of the US Payer payment system or CLFS is a plus.o Ability to manage projects and work cross-functionally (e.g., Market Access, Revenue Cycle Management, Legal, Medical Affairs, Credentialing, Sales etc.).o Ability to communicate effectively on Payer in-network contract and coverage requests submissions in a timely and compliant fashion.o Excellent verbal and written skills.Exhibit strong teamwork skills and collaborative problem-solving skills.o Possess a combination of small / start-up biopharma company experience.
PHYSICAL DEMANDS AND WORK ENVIRONMENT:
· Frequently required to sit· Frequently required to stand· Frequently required to utilize hand and finger dexterity· Frequently required to talk or hear· Frequently required to utilize visual acuity to operate equipment, read technical information, and/or use a keyboard for virtual meetings· Travel Requirements: for internal BG meetings, external Payer-related conferences, and Payer-related customer meetings (20-25%
