Market Access Director

We are seeking a highly motivated Market Access Director to take ownership of securing positive medical policy decisions and driving in-network contracts with regional and national payers for our diagnostic laboratory. This role will be responsible for ongoing strategic innovation, cross-functional collaboration, and the execution of new coverage & reimbursement strategies. This role will engage with health plans, ACOs, IDNs, VA/DoD, and other risk-bearing payers to drive positive policy coverage for our proprietary technology. This remote position does not have any direct reports and reports directly into the VP, Market Access and Reimbursement.

Job Responsibilities:

• Medical Policy Development: Advocate for the creation and adoption of positive medical policies with payers, laboratory management companies, and technology assessors that support the reimbursement of our proprietary test.
• In-Network Contracting: Lead and drive the in-network contracting process with regional and national payers, ensuring our proprietary test is included in payer networks, and achieving favorable reimbursement rates.
• Payer Negotiations: Lead negotiations with insurance companies, including commercial payers, Medicare, Medicaid, lab benefit management companies, and other third-party payers, to secure favorable reimbursement terms for our proprietary test.
• Market Access Strategy Execution: Develop and execute regional and national market access strategies & target pipeline aimed at increasing payer coverage for our proprietary test.
• Stakeholder Relationships: Build and maintain strong, productive relationships with key decision-makers at payer organizations, including medical directors, reimbursement specialists, and policy makers.
• Data-Driven Approach: Work closely with internal teams, including revenue cycle management, sales, and clinical, to gather and present relevant data to support reimbursement and policy decisions, demonstrating the value of our proprietary test.
• Competitive Intelligence: Monitor competitor strategies and market dynamics to identify opportunities and threats in payer contracting and medical policy. Use insights to inform strategy and stay ahead in the market.
• Internal Collaboration: Partner with sales, marketing, clinical, and regulatory teams to ensure alignment on market access priorities and provide insights that help shape the broader strategy.
• Reporting and Metrics: Track and report progress on payer negotiations, market access goals, and key performance metrics to senior leadership, ensuring visibility into success and areas requiring further attention.

Job Qualifications and Skills:

• Bachelor's degree in life sciences, healthcare, business, or related field. Advanced degree (MBA, MHA, or equivalent) is a plus.
• Minimum of 2-5 years of experience in market access, payer contracting, reimbursement strategy, or similar roles within the diagnostics industry.
• Proven experience in driving in-network contracting and securing positive medical policies with regional and national payers.
• Strong understanding of payer requirements, reimbursement processes, and coverage criteria for diagnostic products.
• Ability to manage multiple payer relationships and projects simultaneously with a focus on achieving measurable results.
• Must be able to travel at least 25% of the time.
• Excellent negotiation and communication skills.
• Strong problem-solving abilities to resolve complex payer issues.
• Knowledge of healthcare reimbursement systems, including commercial payers, Medicare, Medicaid, and government programs.
• Ability to present clinical and economic evidence in a clear, compelling manner.
• Ability to analyze payer trends, competitive dynamics, and market access opportunities to inform strategy.
• Strategic mindset with the ability to work independently and drive results.
• Self-motivated, goal-oriented, and results-driven with strong attention to detail.
• Ability to adapt to the fast-changing healthcare and reimbursement environment.
• Strong interpersonal skills with the ability to build relationships and influence key decision-makers.
• Experience with sole-sourced diagnostic tests.