Payer Relations Manager - Central

Job Responsibilities

• Assume and implement assigned projects to increase covered lives and revenue.
• Maintain current knowledge of applicable third-party reimbursement rules and regulations.
• Serve as primary point of contact for assigned private payers.
• Coach physicians in nuances of reimbursement advocacy for Heartflow products.
• Lead discussions with relevant payers to reach positive coverage determinations and optimize contract terms for payment.
• Negotiate, secure, and manage regional contracts with appropriate cross-regional and national payer accounts, including, but not limited to, managed care plans (MCOs), Accountable Care Organizations (ACOs), health systems, insurance companies and potentially, self-insured employers.
• Support key opinion leader development from a payer perspective and provide targeted support to commercial sites to eliminate barriers to access.
• Refine supporting materials from HQ for physician advocacy use with regional payers.
• Support Medical Policy development as required.
• Serve as liaison between payer customers and company personnel on administrative matters.
• Support commercialization strategy with regional sales teams and participate actively in the preparation and execution of regional field sales plans.
• Establish critical relationships with a variety of stakeholders within their geography: health plan medical directors, select practice administrators, key opinion leaders.
• Instill reimbursement confidence within the cardiovascular community to support FFRCT.
• Responsible and accountable for the successful implementation within their territories of the strategic and tactical reimbursement plan for Market Access team.
• May represent company at trade shows, scientific, or other meetings.

Skills Needed

• Experience closing commercial payers for coverage decisions and negotiating contracted rates for the medical device or diagnostics industry (hospital contracting experience a plus).
• Understand the global payer and reimbursement environment, specifically as it relates to coronary artery disease diagnostic testing in the U.S. Must have a solid understanding of coverage, coding, payment, and reimbursement requirements and policies.
• Understanding of key private payer policy infrastructure, payment methodologies, coding and coverage trends.
• Experience developing physician advocates who will testify as to the clinical utility of Heartflow products.
• Demonstrated ability to work with multiple stakeholders in a collaborative and constructive manner.
• Experience working in the field and supporting reimbursement needs of sales team members.
• Excellent written and verbal communication skills, especially with presentation development.
• Early stage company experience preferred.
• Ability and willingness to act in accordance with regulatory compliance requirements, including but not limited to Heartflow’s quality system requirements.

Educational Requirements & Work Experience

• Minimum 5+ years of health care/managed care and reimbursement industry experience.
• BS required. MBA or advanced degree preferred.