National Director Market Access & Reimbursement

AIM OF THE POSITION

The National Director, Market Access and Reimbursement will drive strategies to achieve market access and reimbursement of Agendia’s proprietary test, MammaPrint and BluePrint, and work with private and government payers to secure coverage, optimize reimbursement and serve as a knowledgeable resource in coding, coverage and payment, and provide input for the development of evidence for clinical and economic value propositions.

POSITION WITHIN THE ORGANIZATION

1. Reports to VP, Reimbursement & Gov’t Affairs

2. Cooperates with all departments 

3. Participates in:

– Cross-functional projects and meetings

– Risk assessments and audits

ESSENTIAL DUTIES AND RESPONSIBILITIES

· Work with senior leadership and relevant stakeholders from private and government payors and key opinion leaders to secure coverage and reimbursement.

· Support prior authorizations and claims appeals processes.

· Develop and manage reimbursement collateral, tools, and communications

· Lead value proposition development for non-clinical stakeholders; incorporating economics, reimbursement, and payor requirements.

· Develop relationships with key medical societies, KOLs, CMS, and AMA to secure coding, coverage and reimbursement.

· Design and deliver communication vehicles/marketing materials promoting the clinical and economic value proposition for Agendia products.

· Create health economic analyses that can be translated into useful tools to be used by the sales team.

· Support product launches.

· Collaborate with sales and marketing teams to craft messages for use with physicians, providers, and payers.

· A strong understanding of the commercial and government payor landscape including coverage policies and payment processes. This will include managing and addressing coverage policy issues with payors as necessary.

· Effectively manage demands and needs of multiple programs and customers. Provide high touch program support and build access to key leaders within each organization. 

· Assist our Sales Managers in the development, implementation and management of strategic initiatives.

The above listing represents the general duties considered essential functions of the job and is not to be considered a detailed description of all the work requirements that may be inherent in the position.

KEY CONTACTS

Internal: Works closely with finance, reimbursement, sales, compliance

External: Interacts with existing and potential clients, vendors as well as internal company departments

EDUCATION AND EXPERIENCE REQUIREMENTS

EDUCATION

Bachelor’s Degree in a life science, health economics, health policy or related field.

EXPERIENCE

· 5+ years exp in laboratory coverage and reimbursement with a specific focus in Oncology

· 5+ years of managed care experience, preferably in diagnostics

KNOWLEDGE, SKILLS AND ABILITIES (KSA’S)

Specific Knowledge Required:

Knowledge: Comprehension of a body of information acquired by experience or study.

Skill: A present, observable competence to perform a learned activity.

Ability: Competence to perform an observable behavior.

· Expert knowledge of reimbursement mechanisms across markets and proven success in contracting.

· Outstanding communication skills with demonstrated success in working with cross-functional teams in the development and execution of strategies for acquiring coding, coverage, and payment for new healthcare technologies.

· Strong negotiation skills

· Ability to perform detailed, payer-focused market research both domestic and international

· Executive suite presentation experience (CMO, CFO, CEO, President, VP)

· Prior managerial and leadership experience is strongly preferred

· Business planning skills, both strategic and tactical

· Successful track record with molecular diagnostics contracting and medical policy

· Strong understanding of coding and reimbursement for both commercial and government payers

· Proven track record for consistently meeting or exceeding financial and/or other quantitative targets, as well as qualitative goals

· Ability to communicate effectively and professionally with all members of the organization, customers and external contacts

· Ability to travel with overnights and attendance at some weekend programs

· Ability to translate key scientific information supporting product, competitors, science and

· marketplace to a broad range of Oncology customers

· Advanced knowledge of concepts and practices with the ability to use in diverse business

· situations

· Ability to complete and implement attainable business plans

· Strong understanding of commercial carrier plan designs, state and federal government reimbursement and diagnostic payment channels

· PRIVACY NOTICE:  To review the California privacy notice, click here:  https://agendia.com/privacy-policy/ 

· Employees must not be classified as an excluded individual who is prohibited from participation in any Federal health care program.

BEHAVIOURAL COMPETENCIES/DESIRED SKILLS

o Demonstrates professional, collaborative and positive demeanor 

o Strong ability to manage and deescalate conflict

o Active listener who seeks understanding and displays empathy for opposing viewpoints

WORKING ENVIRONMENT

Establishes ADA (Americans with Disabilities Act) requirements 

ENVIRONMENT/SAFETY/WORK CONDITIONS

Working conditions (inside or outside the office)

• General office environment. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Maintains a clean, neat, and orderly work area.

• Adheres to Department Specific Safety Guidelines.

• Standing, sitting, walking, bending, reaching, manual manipulation, and lifting up to 15 pounds.

TRAVEL

o Ability to drive/fly routinely internationally and domestically for up to 15%

OTHER DUTIES

Other duties as required by management