National Market Access Manager

Transplant Genomics Inc. (“TGI”) is a molecular diagnostics company committed to improving organ transplant outcomes with non-invasive serial monitoring guided by biomarkers. TGI’s product portfolio of both individual and combined whole blood gene expression and donor derived cell-free DNA testing is capable of reliably ruling out subclinical kidney rejection and acute rejection in kidney transplant patients. In addition to kidney transplantation testing, our newest product for liver transplant patients is a blood-based biomarker assay designed to rule out rejection as immunosuppression therapy is optimized.

The National Market Access Manager will partner with and report to the VP of Market Access or Finance Leader and communicate regularly with the Director of Billing. The Manager will be responsible for the oversight and support of administrative and internal operational aspects of the managed care contracting department on a regional and national level. This position would serve as a conduit between Billing, Payor Relations credentialing and enrollment functions and third-party payors, including Medicare and Medicaid programs, to resolve issues related to reimbursement, language, and other disputes to create revenue optimization. If requested, the Manager will fulfill these same functions for other Eurofins third party billing businesses.

Here's what you'll do:

Lead all 3rd party payer contract negotiations and all other contract related discussions with payers

Develop, drive and maintain a contracting strategy for the organization that is cognizant of current market trends and aligns incentives among companies within the Eurofins network of companies

Manage and negotiate national and regional contracts to ensure companies’ objectives are met in a timely manner.

Analyze applicable contracts, associated documents and proposed fees, and negotiate financial terms of contracts

Analyze existing terms to determine if re-negotiation is warranted

Lead payer petitioning endeavors to overturn negative coverage decisions, or to ensure positive coverage decisions for new tests

Serve as the companies’ primary business owner and conduit for each 3rd party payer

Serve as designated participant on Executive Leadership team for clinical companies with third party billing requirements

Monitor, escalate and summarize potentially problematic contract provisions and regulatory issues to management as it relates to payer contracting.

Interface with internal departments such as Payor Enrollment, Revenue Cycle, Analytics, Finance, Quality Management, and Legal.

Develop and maintain relationships with operational counterparts at payors and regulatory bodies nationally.

Work with external legal counsel to investigate and evaluate national and state payor market regulatory statues.

Assist with the development and maintenance of department policies and standard operational procedures, in collaboration with underlings on the Payor Relations’ department, ensuring compliance.

Create third-party tools to create a Payor policy database specific to the tests Eurofins performs.

Create a dynamic fee schedule/reimbursement matrix and database.

Resolve payor related reimbursement and contract language interpretation issues.

Seek and find increased revenue opportunities through claims investigation, analysis of billing patterns/interfacing with billing and payer contractual non-compliance.

Perform data analysis from a variety of data sources to evolve the metrics used to measure effectiveness and return on investment of all current and new product activity.

Model and run payment analysis reports in Excel and other modeling programs from SAS data downloadable from our Xifin billing system

Monitor, identify, summarize and maintain a repository of applicable regulatory and contractual requirements (i.e. No Surprise Bill state legislation, Medicare/Medicaid required contract language etc.).

Serve as a project manager for any directed projects.

Understand and investigate as needed, and disseminate, information to the managed care contracting department and billing, operations and sales of any new WC, Auto, Medicaid, CMS or health plan products introduced into the market place.

The ideal candidate:

Bachelor degree in Business Administration, Finance, Accounting and/or Information Systems required.

Master’s Degree preferred.

Ability to lead of team of diverse skill-sets and age groups.

Strong interpersonal skills; strong written, verbal and analytical skills; ability to adhere to deadlines; work to get the job done “right the first time”.

Minimum 8 years healthcare administrative experience.

Must be a self-starter with the ability to organize and multi-task multiple tasks/projects to completion.

Professional business sense; strong knowledge of payor reimbursement methodology types

Proficient in creating and utilizing MS Excel spreadsheets and all other MS Office programs, business intelligence tools, and/or other reportable performance programs.

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