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Description
The Director, Payor & Customer Engagementwill manage all payor affairs and customer engagement in the area of market accessfor bioMérieux. This position will be a key member of the US Market Access and Government Affairs team. The Director will be responsible for setting the strategic direction for the team(s) and ensuring that all affairs are conducted in accordance withUS regulations and bioMérieux’s compliance policies and protocols. This position will be the US expert on coverage, coding, payer medical policy processes, and payment issues thatcould impactproducts inbioMérieux’s portfolio. The Director will define field strategies to maximize coverage and reimbursement for bioMérieux’s products. Extensive experience with and understanding of all reimbursement methodologies employed within the US healthcare system.
Primary Duties:
Perform all work in compliance with company quality procedures and standards.
Provide guidance and manage Payor and Customer Engagement personnel.
Set the strategic direction for the respective payor and customer teams to drive coverage and reimbursement from US commercial payors, andcollaborates on strategic direction for CMS, MACs, in conjunction with Government Affairs &Market Access Leadershipin support of bioMérieux’s customers.
Own the creation of advocacy campaigns to encourage customer groups to facilitate reimbursement or coverage strategies with payors.
Manage working relationships with CMS, Medicare Administrative Contractors (MACs), National payors, health technologies assessment organizations and medical groups and be versed in capitated / delegated risk models.
Manage, facilitate, and provide detailed reports of all activities addressing customer escalation issues addressed by internal protocol.
Own the entirety of the bioMérieux portfolio and relationships with the consultants and third-partyproviders engaged for both payor and customer initiatives.
Ensure all work performed by the team is in compliance with company policies and standards, government laws and regulations.
Attend regional or national professional society and payer meetings/conferences as needed to educate current and potential customers on reimbursement issues and to gain support for market access through policy and/or clinical guideline development.
Work cross-functionally with sales leadership, strategic accounts, and US marketing to maximize pull-through and leverage available resources to drive payor acceptance.
Travel with field sales team members to support and educate customers with identified reimbursement challenges and to gain support for payer education strategies.
Participate in regional and national sales meetings as needed and provide training where necessary.
Perform other duties as assigned.
Training and Education:
Bachelor’s degree,in science/healthcare and/or advanced science, public health or allied healthcare degree or minimum of 12 years’ experience in health insurance or managed care industry working for a health plan or large hospital system.
MBA or MPH is a plus.
Experience:
Minimum of 10 years’ experience in health insurance or managed care industry working for a health plan or large hospital system; 20 years’ experience preferred.
Must possess5years’ experience in provider relations/network developmentwith additional experience in claims administration, health care policy; 15 years’ experience preferred.
Diagnostic experience preferred.
Minimum of 5 years’ experience managing a provider relations team; 10 years’ experience preferred.
Familiarity with the in vitro diagnostics and/or medical device industry.
Experience in partnership models with health systems and payors.
Strong understanding of compliance-related concepts including the laws, regulations, and policies that govern marketing and sales activities and the importance of compliance in all job-related functions.
Experience in working with Medical Group Medical Directors and a firm understanding of capitated/delegated risk models.
Knowledge, Skills, and Abilities:
Must understand how to impact process with payors for obtaining coverage decisions and advancing medical policy with demonstrated success in obtaining coverage, access, reimbursement from health plans in prior roles.
Ability to build and develop customer relationships including the ability to effectively represent bioMérieux and its products to senior levels of management and key thought leaders.
Innovative thinking and exceptional business acumen, analytical and problem-solving skills.
Strong understanding of compliance-related concepts including the laws, regulations, and policies that govern marketing and sales activities and the importance of compliance in all job-related functions.
Strong presentation skills required.
Strong influencing and negotiation skills.
Strong analytical, problem solving, and decision-making skills.
Strong matrix management skills.
Strong understanding of business management preferred.
Domestic Travel: 40% International Travel: 5%
Full Time
$176k-243k (estimate)
12/14/2023
07/02/2024