Department: Patient Access and Healthcare Policy
Reports To: Sr Director, Patient Access and Healthcare Policy, Blue Earth Diagnostics, Inc
At Blue Earth Diagnostics, our mission is to transform the clinical management of patients with cancer by developing innovative molecular imaging technologies. Our team is made up of industry leaders in the field of radiopharmaceutical development and commercialization. Blue Earth Diagnostics is a dynamic and growing company with an approved product already on the market in the USA and in Europe. Blue Earth Diagnostics is backed by Syncona plc, an investment company listed on the London Stock Exchange.
Reporting to the Director, Patient Access and Healthcare Policy, the Payer Relations Manager position is a critical role to ensure reimbursement of a novel diagnostic radiopharmaceutical that was approved by the FDA in May 2016. The scope of the role includes continuous monitoring and payer outreach to maintain or improve continued existing and expanding coverage, proper claims processing, and internal/external customer support.
The incumbent will be ready to bring his or her previous payer experience and relationships into a setting that has a strong existing reimbursement foundation with Medicare coverage, a product-specific code and transitional pass-through payment in the Medicare hospital setting. The critical next steps are to assure Medicare Advantage/Managed Medicare, commercial plans, and radiology benefits managers (RBMs) cover the product appropriately. Ongoing internal and external customer support is essential to the success of patient access for the product.
Key success factors for this role include experience and competence in relationship building, concise presentation of complex healthcare policy and reimbursement information, and the ability to quickly identify solutions to address both customer and business needs.
Candidates will be comfortable working in a small start-up environment and will have led high performance organizations in accomplishing stretch objectives in a quick-paced, patient focused culture.
Essential Duties and Responsibilities:
- Performing and communicating analysis of the payer landscape in various markets across the US; including creating and updating coverage status reports for executive management
- Developing / maintaining relationships with identified key payers
- Attending payer, medical society, or other related meetings to network with payers
- Presenting the value proposition and health economic model to payers
- Coordinating with reimbursement support line consultants, where appropriate, to provide updates, guidance, and address challenges with reimbursement as reported by users
- Providing expert guidance to Field Reimbursement Specialists to enable them to educate users on accurate claims submission, understanding of reimbursement landscape, and where appropriate, liaise with payers
- Working collaboratively with other functional areas to develop educational materials; providing expert tactical guidance when needed
- Other projects as determined through discussion and planning with Director of Patient Access and Healthcare Policy
To perform the job successfully the individual should demonstrate the following competencies:
- Interpersonal Skills and Ethics – A natural focus on “team”, with a resourceful and collaborative approach to working. Treats people with respect; inspires and earns the trust of others; conducts all activities with integrity while observing all relevant laws, regulations, ethical standards and conventions.
- Oral and Written Communication – Actively listens and responds effectively to questions; leads effective meetings; able to effectively prepare and then communicate options and recommendations pertaining to reports, reporting improvements, and overall CRM-system considerations for the betterment of the team.
- Cost Consciousness and Organizational Support – Works within approved budget; conserves organizational resources and offers suggestions on how to accomplish individual and business goals more efficiently and effectively at lower costs. Observes policies and procedures; completes administrative tasks consistent with company policies and on time; supports organizational goals and values; contributes to evolving culture.
- Planning/Organizing and Dependability – Is highly organized; prioritizes and plans work activities; uses time efficiently; sets goals and objectives with realistic action plans; proactively checks self against objectives and modifies as needed.
- Initiative and Innovation- Undertakes self-development activities; seeks increased responsibilities; looks for and takes advantage of opportunities; asks for and offers help when needed. Displays original thinking and creativity; meets challenges with resourcefulness; generates suggestions for improving work.
- Bachelor’s degree required with 3-5 years working in reimbursement, managed care sales / marketing or related field
- 5+ years demonstrated experience and success in healthcare industry, preferably imaging, diagnostics, or pharma
- Understanding of, and access to, national payers, regional payers, and medical directors
- Ability to work directly with hospitals/imaging centers on payer specific issues
- Knowledge of medical benefit plan design (Commercial, Medicare, Managed Care)
- Ability to lead/coordinate local market access on reimbursement issues
- Highly developed time management skills with demonstrated ability to meet deadlines and handle multiple priorities with a high degree of initiative required.
- Well-developed analytical, problem solving, and influencing skills, appropriately balanced with strong interpersonal and teaming skills
- Excellent communication (written, verbal, and presentation) skills with ability to interact with all levels of management for both internal and external customer base
- Demonstrated ability to successfully manage high impact relationships and projects
- Strong advising, facilitation, and organizational skills; team player. Experience and skills with cross-functional and highly matrixed organizations
- Ability to work effectively and independently from a home office, but must be able to travel as needed (up to 50% of the time)
- Basic knowledge of compliance aspects relative to industry and reimbursement policy
- Qualified candidate must be legally authorized to be employed in the United States
How to Apply:
To apply, please submit your CV and a covering letter with the title of this job in the subject line to firstname.lastname@example.org outlining:
- Why this role appeals to you
- How your background and skills are suited to this role
Blue Earth Diagnostics offers competitive compensation for high-caliber candidates.
Blue Earth Diagnostics, Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, ethnic/national origin, military and/or Veteran status, age, disability, genetics, marital status, sexual orientation or medical condition in accordance with applicable federal, state and local laws.