Sr. Manager of Market Access, Clinical Support

The Position:

The Sr. Manager of Market Access, will be an individual contributor role focused on supporting the clinical and medical policy-related aspects of Market Access and Reimbursement Operations initiatives to drive coverage and contracting efforts. This role will operate within the Market Access team but will collaborate closely with the Reimbursement leadership (and other departments) to support aspects of the operations requiring clinical and medical policy input.   This will include duties like creating and updating content for appeal letters, writing personalized appeal letters tailored to the individual patient’s medical history, and participating in peer-to-peer/external review appeals for key scenarios.

This position’s responsibilities will align with three focused areas:

(1) Partnering with Market Access, Medical Affairs, Marketing and Reimbursement leadership to optimize the appeals content necessary to support coverage and appeal efficacy initiatives. 
(2) Be the key face of Veracyte in peer-to-peer and external review initiatives with a targeted list of payers in order to positively affect medical coverage polices for Veracyte’s portfolio of testing.
(3) Lead the creation and management of content such as dossiers, presentations, etc. needed to support coverage and contracting initiatives with payors and Laboratory Benefit Managers (LBMs).

Specific Responsibilities

• In collaboration with cross-functional teams, support the development of content leveraging clinical, scientific, and health economic data, targeted to key healthcare decision-makers responsible for making medical policy and/or coverage decisions at health insurance companies and LBMs as needed.
• Support engagement with Healthcare Practitioners (HCPs) and patient advocates to reinforce coverage/contracting initiatives.
• Participate in Market Access, Reimbursement Operations, and other cross-functional team meetings.
• Update and maintain appeals content (with a focus on clinical and medical policy aspects) in response to changes to payor medical policies, State Biomarker laws, and general healthcare trends
  • Requires monitoring and tracking changes to relevant medical policies
• Create customized appeals content specifically targeted to strategic coverage and contracting opportunities identified as needed.
• Plan, execute, and participate in peer-to-peer and external review appeals.
• Initiate, track, and report submissions to state departments of insurance regarding complaints or disputes of non-covered claims
• Conducts the necessary research and detailed review of patient medical records in order to determine if medical necessity criteria were met and craft personalized appeal letters demonstrating the clinical value of our services for individual patients as needed.

Who You Are:

We require this position to have a clinical background. The ideal candidate would be a physician, nurse, genetic counselor, or medical science liaison with clinical experience as well as experience in overturning coverage decisions in the setting of peer-to-peer conversations with insurers. The person will be highly respected and maintains collegial relationships with peers.  The ideal candidate will be a creative thinker who enjoys participating in the development of novel approaches to transform medical care.  Specific requirements include the following:

• Advanced degree in life sciences with one or more of the following: MD, DO, PharmD, PA, RN, PhD, MS
• Significant background or knowledgebase in diagnostics and oncology
• 10+ years of experience within healthcare, and 5+ years of experience in laboratory reimbursement.
• Possess a willingness and ability to work hands-on and with a sense of urgency in a fast-paced, scientific, entrepreneurial environment
• A deep understanding of US healthcare ecosystems, payer landscape, payer medical policies, coding, and reimbursement frameworks
• Excellent listening and communication skills with the ability to maintain open communication with people of all backgrounds and expertise inside and outside the Company
  • Proven ability to successfully communicate, consult, collaborate and coach in a complex and competitive environment
  • Ability to translate complex medical messages into communications that are understood by each target audience
  • Ability to distill large complex clinical data sets into meaningful and understandable messages
  • Ability to anticipate payer objections and craft compelling evidence-based arguments
• Flexibility to travel +/- 20% of the time to meet with key physicians and payers and attend industry events domestically.
• Warm, engaging personality with highly developed influencing skills and ability to represent the Company and its products/services with credibility.
• Strong team player with excellent interpersonal skills and the ability to work cross-functionally throughout the Company
• Leadership ability to build team consensus
• Possess a willingness and ability to work hands-on and with a sense of urgency in a fast-paced, scientific, entrepreneurial environment
• Impeccable ethics, conducting business in the most professional and HIPAA-compliant manner possible
• Desire to help patients by improving access to quality diagnostic testing