Payer Relations Manager - East Coast

The individual will be responsible for the identification, development, and management of strategic relationships with payers and organizations that influence payer decision-making within their assigned geographic region. The person will work directly with the Market Access team including the sales, implementation, and billing specialist teams within their respective regions and will serve as a resource for identification and resolution of payer related issues. The person will be responsible for regional managed care organizations within their assigned geography. This person will also interact within a broader Market Access team and ultimately be responsible for implementation of tactical plan developed by the market access leadership team.

 In addition, this position will provide critical competitive intelligence within the market access marketplace to leadership. The individual will assist in the development of the local market access strategic plan for Heartflow’s FFRCT­ Analysis. The ultimate goal of the position is to minimize FFRCT access barriers and to achieve favorable coverage policy and reimbursement contracts for Heartflow products with commercial payers as well as support other billing and collections projects as needed. #LI-IB1; #LI-Remote

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.
• Negotiating, securing, and managing 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.
• Support the team in determining regional payer account strategy and tactics.
• 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.

Required Travel: Up to 20%

This position has an estimated base salary of $140,000-$145,000 per year, variable pay of up to $50,000 per year, and includes initial stock grant.