Director of Reimbursement and Payer Strategies [Ref 2673777] – Cambridge, MA
Exosome Diagnostics is a privately held company focused on developing and commercializing revolutionary biofluid-based diagnostics to deliver personalized precision healthcare that improves lives. Exosomes are messengers released by all living cells into biofluids, such as plasma/serum, urine, cerebrospinal fluid and saliva, forming a highly enriched source of RNA, DNA and proteins from their cell of origin. Our proprietary exosome-based technology platform can yield comprehensive and dynamic molecular insights about cells in the body without direct access to the actual cells. Through this novel technology, we are focused on transforming how cancer and other serious diseases are detected, diagnosed, treated and monitored. In 2016, we will launch multiple diagnostics, including liquid biopsy tests for lung, prostate and other solid tumor cancers.
As we transform the Company to a commercial enterprise, we are expanding the organization and are seeking an experienced Director of Reimbursement and Payer Strategies to drive and help build this key function. Reporting to the Chief Operating Officer, the Director of Reimbursement is responsible for developing, implementing, and managing all aspects of the pricing, reimbursement and market access strategy across all products and key customer segments and will play a leading role in helping to evolve our billing infrastructure to support the reimbursement requirements. You will work in close collaboration with Marketing, Sales, Medical Affairs, Legal, Finance, Regulatory, and Clinical Operations for a growing medical diagnostics company. You will analyze third party payer coverage and reimbursement in terms of existing and emerging payer policies, utilization management, competitive landscape, trends, potential barriers to provider and patient access.
As the Director of Reimbursement you will play a key role in educating and influencing key opinion leaders regarding improved outcomes and clinical utility for the company’s products and services. Key market functional areas could include patient access programs, market access strategy, commercial managed markets, and government markets for both existing products – and exciting products in R&D pipeline.
- Lead development and execution of practical strategies to secure optimal reimbursement for the company’s products.
- Continuously develop in-depth knowledge on current healthcare economic topics of relevance to company products for the United States (and WW) (i.e. healthcare reform, accountable care organizations, value based purchasing, quality initiatives, health technology assessments, oncology pathways, etc.) by staying current on changes in reimbursement environments via literature review, internet research, networking, consulting reports and attending meetings.
- Participate and support development of strategic business plans, budgets and internal forecasts and reporting functions as necessary and required.
- Monitor and interpret all payer (private and public) policy and regulations.
- Develop and execute specific value propositions and reimbursement strategies.
- Managing the coding, coverage and payment processes within the United States for all company products and services impacted.
- Maintain up-to-date knowledge of industry trends, economic and reimbursement elements for products of competitors.
- Lead implementation of tactical planning activities required to achieve health economics and reimbursement strategic objectives (e.g., preparation of economic and reimbursement dossiers for payer negotiations, new code applications, customer billing guides, billing infrastructure, etc.).
- Facilitate meetings with health care professionals, payers, CMS, and reimbursement and economic consultants as required to support strategic development, rollout, or tactical implementation.
- Supports sales team with reimbursement related issues.
- Develop and support new product launches as it relates to the business development role including reimbursement, market analysis, business plans and healthcare economics etc.
- Support sales with topics of relevance to healthcare economics & business development (e.g. financial feasibility, market analysis as it relates to third party payer reimbursement).
- Facilitate and coordinate physician advocacy as necessary in support of payer policy intervention.
- Demonstrate excellence in meeting and exceeding customer expectations especially in difficult situations.
- Address customer concerns in a timely fashion and by working collaboratively with external and internal stakeholders.
- Develop tools and documents for sales, marketing, and clinical projects associated with specified responsibilities of this job.
- Demonstrate excellent presentation skills for internal management and with customers.
- Work with consultants and/or design and develop health care economic models and tools
- Manage and negotiate external vendor/consulting contracts for approved projects
- Work within budget to support strategies and tactics and manage to plan
- Experience in reimbursement including knowledge of public and private funding streams, coding/coverage/payment, and process for policy development and implementation
- Minimum of ten years management experience, preferably in a health care environment
- Ability to strategize for reimbursement and regulatory issues
- Ability to work with boards and government parties to review reimbursement and regulatory issues
- Excellent verbal and written communications
- Superior Excel and Power Point skills
- Strong presentation skills
- Estimated travel: 25%
- Bachelor’s Degree Required
- Advanced Degree Preferred
What We Offer
- Competitive salary/benefits package and an attractive location in the vibrant Boston/Cambridge community of biotech and academic research.
- Opportunities to enhance your career with an emerging organization poised for significant growth.
- Base Salary: Commensurate with experience
Note: This job description is not intended to be all-inclusive and may have been abbreviated or maximized for online or mobile viewing. Employee may perform other related duties as negotiated to meet the ongoing needs of the organization.
How to apply: Interested candidates should submit a resume (Word or PDF format) to firstname.lastname@example.org. Please put  Director of Reimbursement and Payer Strategy in the subject line.