National Market Access Manager

About the role

Transplant Genomics Inc. ("TGI") is a molecular diagnostics company dedicated to enhancing organ transplant outcomes through non-invasive serial monitoring using biomarkers. TGI offers a portfolio of whole blood gene expression and donor-derived cell-free DNA testing to reliably rule out subclinical kidney rejection and acute rejection in kidney transplant patients. Additionally, TGI has developed a blood-based biomarker assay for liver transplant patients to monitor rejection during immunosuppressive therapy optimization.

Responsibilities

• Lead all third-party payer contract negotiations and other contract-related discussions with payers
• Develop, drive, and maintain a contracting strategy aligned with current market trends and company objectives
• Negotiate financial terms of contracts and analyze existing terms for potential renegotiation
• Lead payer petitioning efforts to overturn negative coverage decisions or secure positive coverage for new tests
• Interface with internal departments such as Payor Enrollment, Revenue Cycle, Analytics, Finance, Quality Management, and Legal
• Create third-party tools for a payor policy database specific to Eurofins' tests
• Create a dynamic fee schedule/reimbursement matrix and database
• Resolve payor-related reimbursement and contract language interpretation issues
• Seek and pursue increased revenue opportunities through claims investigation and analysis
• Perform data analysis from various data sources to measure effectiveness and ROI of product activity
• Model and run payment analysis reports in Excel and other modeling programs from SAS data
• Monitor, identify, summarize, and maintain a repository of applicable regulatory and contractual requirements
• Work with external legal counsel to investigate and evaluate national and state payor market regulations
• Assist with the development and maintenance of department policies and standard operating procedures
• Understand and disseminate information about new WC, Auto, Medicaid, CMS, or health plan products introduced into the market

Qualifications

• Bachelor degree in Business Administration, Finance, Accounting, or Information Systems required
• Master’s Degree preferred
• Strong interpersonal and communication skills
• Minimum 8 years healthcare administrative experience
• Experience working with multiple state payors preferred
• Proficiency in creating and utilizing MS Excel spreadsheets and other MS Office programs
• Ability to process and understand complex information related to managed care environments
• Strong familiarity with managed care terminology and contact provisions
• Experience in compiling, coordinating, and analyzing payor contract regulatory requirements and contract language
• Ability to maintain high levels of confidentiality regarding sensitive corporate data
• Ability to work outside regular business hours as needed

Physical Requirements

• Physical dexterity sufficient to use hands, arms, and shoulders repetitively to operate a keyboard and other office equipment
• Continuous operation of a personal computer for extended periods of time (4 or more hours)
• Mental acuity sufficient to collect and interpret data, evaluate, reason, define problems, establish facts, draw valid conclusions, make valid judgments and decisions

Additional Information

• Schedule: Monday-Friday, 8:00am-5:00pm
• Benefits: Comprehensive medical, dental, and vision coverage; life and disability insurance; 401(k) with company match; paid vacation and holidays
• Equal Employment Opportunity Employer: Eurofins USA Clinical Diagnostics is committed to hiring a diverse workforce