Director Market Access Value-based Accounts

The Director of Market Access, Value-Based Accounts will lead reimbursement and market access strategy for the various state Medicaid plans across the country as well as key regional accounts with alternative, value-based, reimbursement models that are typically “risk-bearing” care organizations, i.e., independent physician associations (IPA), county public health systems, integrated delivery networks (IDN), accountable care organizations (ACO), and managed care organization (MCO).  These “risk-bearing” organizations do not typically follow a traditional fee-for-service payment model and require specific focus and expertise in value-based care delivery in order to maximize market access and reimbursement. This individual will report directly to the Executive Director of Market Access. This position is a hybrid role based out of our South San Francisco or San Diego. We are also open to remote PST.

The Director’s responsibilities will align along seven focused areas:

(1.) Manage and track state Medicaid credentialing, coverage policies and reimbursement rates relevant to Veracyte’s portfolio of products

(2.) Identify gaps in state Medicaid reimbursement and prioritize activities such as credentialing, enrollment, coverage, establishing fee schedule rates, and contracting with MCOs

(3.) Support state-level government affairs initiatives such as ensuring proper implementation and application of state biomarker laws relevant to our portfolio of products

• Implement state-level appeals strategy in collaboration with Billing
• File complaints where appropriate with state departments of insurance
• Implement engagement strategy with health plans and LBMs that are not aligned with state biomarker laws

(4.) Collaborate closely with field sales to grow accounts where reimbursement issues have limited access; this will require in-person co-selling

• Gain physician and administrative support
• Contract where needed
• Respond to RFPs from public health systems such as county hospitals

(5.) Partner with the broader Market Access team, Billing, Marketing, Medical team, and consultants to improve reimbursement and revenue

(6.) Develop and maintain an operating plan that tracks KPI and provides forecast for future contracts, coverage, and new account opportunities

(7.) Gain and develop a deep understanding of Veracyte’s entire portfolio of products, trends in healthcare reimbursement, and each account’s challenges and initiatives to inform reimbursement strategy

(8.) Coordinate with various global corporate functions to build evidence of value demonstration across multiple products

This individual should be highly motivated, results-driven and have a strong track record in payor relations, market access, or managed care landscape. Specific requirements include the following:

• Established deep and wide relationships with payors, IDNs, IPAs, MCOs, and public health systems
• Deep understanding of the U.S. healthcare reimbursement landscape, including knowledge of payer systems and medical policy, specifically in the diagnostics space
• Strong team player with experience working with cross-functional teams (billing, analytics, sales, marketing, medical, etc.)
• Excellent strategic thinking skills, with demonstrated ability to successfully lead the ideation, development of a plan, and move to action
• Excellent written and verbal communication skills with the ability to maintain open communication with people of all backgrounds and expertise inside and outside Veracyte
  • Ability to translate complex medical messages into communications that are understood by each target audience
• Warm, engaging personality with highly developed influencing skills and ability to represent Veracyte and its products/services with credibility
• Understand health economic models, coordination with medical personnel, KOLs and consultants to produce compelling demonstrations of value
• Impeccable ethics, conducting business in the most professional manner possible
• Desire to help patients by improving access to quality diagnostic testing

• Bachelor’s degree required, PhD or other advanced degree preferred
• 5+ years of work experience in market access/payer relations/managed care/health economics in the diagnostics space
  • Prefer experience at a diagnostics lab with a menu of proprietary advanced genomic “laboratory developed tests”
• Extensive experience working with state Medicaid programs and payers with alternative payment models is required
• Experience with state-level government affairs is preferred but not required
• The business opportunity requires this field-based position to be located on the West Coast, preferably in California
• Proficient in Teams, Powerpoint, Excel and Tableau
• Flexibility to travel 20-40% of the time to meet with accounts, payors and attend industry events domestically

#LI-Hybrid #LI-Remote