Director - Medicaid Accounts

Position Summary

The Director of Medicaid Accounts is responsible for coverage initiatives with Medicaid Fee for Service and Managed Medicaid plans. Responsible for obtaining positive coverage policies, contracting, completing provider enrollments and maximizing reimbursement while minimizing access barriers for patients and providers. Travel is required at requested times, outside of incumbent’s region to provide national support. Ability to manage complex contracting documents ensuring business needs are met within the agreements and make recommendations on legal review and pull-through initiatives coordinated with marketing and sales teams.

This position is field based.

Job Responsibilities

• Complete state Medicaid enrollments and work to gain coverage through FFS Medicaid, including policy and coding coverage.
• Contract to be an in-network provider with Managed Medicaid plans. Manage complex contract negotiations and work with cross functional departments to ensure contract performance and pull through.
• Develop and implement strategies that lead to successful acceptance of Caris Life Sciences testing into medical policy guidelines and add codes to state fee schedules.
• Stay up to date on trends in the managed care market and develop strategy with senior management to address the changes and maintain acceptable reimbursement rates.
• Build alliances with patient advocacy groups, professional societies, and key opinion leaders to ensure a unified voice in support of coverage and payment policies.
• Prepare responses to Request for Proposals (RFP).
• Assist field representatives with reimbursement challenges.
• Attend conferences and physician meetings.
• Uphold company mission and values through accountability, innovation, integrity, quality, and teamwork.
• Support and comply with the company’s policies and procedures.
• Collaborate with all teams including Operations, Account Management, Analytics, Billing and Sales to ensure contract performance is being met and to identify new opportunities/challenges.
• Actively pursues opportunities and assesses market trends to drive initiatives which enhance company's market position.
• Assure that applicable operating policies, procedures, and standards are followed.
• Supervise and train team members as needed.
• Always represents the organization well; support its mission, goals and objectives; participate as a “team player”, constantly supporting other managers; set an example of high personal and professional conduct for employees and others.
• Reporting: Maintenance and distribution of the monthly Medicaid Payor Reports.
  
  

Required Qualifications

• Bachelor’s degree in business, marketing, science, or related field.
• 5 years of experience in any of the following areas: contracting and coverage with Medicaid and managed Medicaid organizations, medical group contracting, sales, sales leadership in biotech, device or diagnostic laboratory companies, or extensive experience working in health plan contracting, coverage or case management.
• Extensive knowledge of reimbursement programs in pharma, lab, biotech, and/or device.
• Proficiency in Microsoft, Excel and PowerPoint is required.
• Revenue cycle and fee schedule management.
• Possession of a valid driver's license.
• Demonstrated ability to perform the essential duties of the position with or without accommodation.
• Authorization to work in the United States without sponsorship.
• Strong presentation skills and the ability to speak confidently to all levels of an organization require.
• Ability to develop a value proposition and effective business case that will influence medical policy.
• Ability to present clinical data, scientific findings, and complex information in a persuasive manner to a variety of audiences.
• Outstanding influencing, interpersonal and networking skills to drive successful relationship building.
  
  

Preferred Qualifications

• Proven success working with state Medicaid’s that yield reimbursement at desired ASP.
• Reimbursement contracting and coverage experience, preferably in molecular diagnostics or life sciences.
• Able to work independently with little direction, capacity to research and stay current on managed care and healthcare industry trends.
• Possess a solid understanding of the molecular diagnostic testing market: products, companies, and technology.
• Demonstrated track record of developing and managing complex negotiations with multiple decision makers.
• Outstanding problem solving, project and program management skills.
• Proven, effective time management, expense reporting, prioritization, and delegation skills.
• Effective presentation skills: able to present ideas to customers in a way that produces understanding and impact.
• Existing relationships with individuals at insurance companies and group payer organizations.
• Project management skills are a plus.
  
  

Physical Demands

• Ability to lift to 10 pounds for approximately 10% of a typical working day.
• Ability to work seated for approximately 80% of a typical working day Ability to work standing for approximately 20% of a typical working day.
• Ability to work in front of a computer screen and/or perform typing for approximately 80% of a typical working day.
• Ability to comply with any applicable personal protective equipment requirements.
  
  

Training

• All job specific, safety, and compliance training are assigned based on the job functions associated with this employee.
  
  

Other

• Ability to travel approximately 30% of working time within region and limited time outside of region for national or regional meetings.
  
  

Annual Hiring Range

$180,000 - $195,000

Actual compensation offer to candidate may vary from posted hiring range based upon geographic location, work experience, education, and/or skill level. The pay ratio between base pay and target incentive (if applicable) will be finalized at offer.

Description Of Benefits

• Highly competitive and inclusive medical, dental and vision coverage options
• Health Savings Account for medical expenses and dependent care expenses
• Flexible Spending Account to pay for certain out-of-pocket expenses
• Paid time off, including: vacation, sick time and holidays
• 401k match and Financial Planning tools
• LTD and STD insurance coverages, as well as voluntary benefit options
• Employee Assistance Program
• Pet Insurance
• Legal Assistance
• Tuition Assistance
  
  

Conditions of Employment: Individual must successfully complete pre-employment process, which includes criminal background check, drug screening, credit check ( applicable for certain positions) and reference verification.

This job description reflects management’s assignment of essential functions. Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

Caris Life Sciences is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.