Job Details
Qualifications
- Bachelor of Science
- Bachelor's degree
- Computer networking
- Contracts
- Laboratory experience
- Medical coding
- Negotiation
Job Description
Job Title: Director, Managed Care & Payer Relations
Department: Reimbursement
Reports To: President and CEO
Location: Trumbull, CT
POSITION SUMMARY
The Director, Managed Care & Payer Relations is responsible for working with third party payers, including Medicare, Medicaid, IDN’s, and Commercial providers, to ensure the Company’s products are considered covered, medically necessary, and contacted on an in-network basis. This includes negotiating favorable pricing and other contract terms, presenting clinical evidence to Medical Directors and Technology Assessment function personnel. Further, this individual will be responsible for ensuring all pertinent documents are up to date and provide the most compelling value proposition possible, e.g., clinical dossier, peer-reviewed publications, etc. In addition, the Director, Managed Care & Payer Relations will be responsible for working with guidelines and specialty physician organizations to ensure Aspira’s products are incorporated into treatment algorithms. This individual will also be responsible for working with Technology Assessment organizations to ensure current reviews of Aspira’s technologies. This individual will also be responsible for representing Aspira at Managed Care and payer industry forums and conferences to ensure the Company is aware of the latest trends in contracting for lab services. This individual will also be responsible for working with the Sales organization to ensure pull-through of coverage and contracts with all payers.
ESSENTIAL FUNCTIONS
Keen understanding of the payer technology assessment process.
Negotiate coverage for all Aspira products with all third-party payers including Medicare, Medicaid, Commercial, Medicare Advantage.
In concert with the Manager, Credentialing and Contract Management, ensure the Contract Database is current and reflects the company’s status with all payers.
Negotiate in-network contracts with all plans and favorable contract terms including pricing.
Work with field Sales team to develop and implement contract pull-through strategies to leverage the benefits of contracted payers.
Identify and develop strong working relationships with senior Medical and Technology Assessment. leadership within health plans to ensure coverage of all current and future Aspira products.
Work with Sales and other teams to prepare reimbursement strategy for all future product launches.
Re-negotiate current contracts to include new products.
Coordinate reviews of Aspira’s tests with technology assessment organizations, e.g., Evidence Street, Hayes, ECRI, other.
MINIMUM QUALIFICATIONS
BA or BS required.
5+ years in managed care in laboratory industry negotiating with managed care and payer organizations.
Strong knowledge of billing, coding, and reimbursement.
Demonstrated success securing coverage and contracts for new testing technologies.
Experience negotiating in-network lab contracts with favorable terms including pricing.
Must have existing relationships with key payers.
Experience negotiating coverage for diagnostic laboratory testing services.
KNOWLEDGE, SKILLS, AND ABILITIES
Excellent written and oral skills.
Ability to engage and collaborate with other Departments within the organization.
Ability to develop and maintain relationships with key contacts within payer organizations, particularly Medical Directors and Network Management personnel.
The ideal candidate will have prior experience and success with companies in relevant industry (Lab, Biosciences, Diagnostics etc.).
SUPERVISORY RESPONSIBILITIES
The Director of Managed Care and Payer Relations has supervisory responsibility over the Manager of Credentialing and Contracts.