Market Access Manager Medicaid

Summary of Major Responsibilities

Candidates must be located near a major airport to meet the travel requirements of this position.

 

 

The Market Access Manager Medicaid drives medical policy coverage initiatives, and pricing strategies within assigned state Medicaid programs. The position supports Market Access public sector strategy and implementation, directed on a national level by the Associate Director, Market Access. The Market Access Manager will target specific key initiatives, for example, top tier Medicaid states and collaborate on timing of enrollment and contracting with large Medicaid HMO providers.  Liaises with revenue cycle management and legal, and makes recommendations on state enrollments, billing, fee schedule maintenance and global Medicaid strategy. Calls on government payer organizations, in collaboration with the Market Access team that impact reimbursement nationally, developing coverage policy; provides technical and administrative product information and responds to requests for proposals.  Travel is required up to 70% within key US Markets, and Exact Sciences headquarters in Madison WI, to provide national support and drive cross-functional market access initiatives.

Essential Duties and Responsibilities

  • Manage complex national payers and Medicaid HMO contract negotiation/state fee schedules and work with cross-functional departments to bring the process to closure.
  • Manage existing relationships with existing contracted insurance companies.
  • Develop and implement strategies that lead to successful acceptance of Exact Sciences testing into government payer medical policy guidelines.
  • Maximize reimbursement by negotiating the highest possible reimbursement rates for state fee schedules and Medicaid HMOs and large national payers where assigned.
  • Stay up to date on trends in the commercial payer and Medicaid market and develop strategy with senior management to address the changes and maintain acceptable reimbursement rates.
  • Prepare, coordinate and manage Medicaid strategy around expansion states, prioritization of resources.  This includes prioritization of key market health systems and provider targets with higher weight to Medicaid populations.
  • Assess potential legal risk in the context of contract provisions. Prepare letters of agreement and key contract provisions.
  • Initiate and develop relationships, track history and progress.
  • Serve as the principal contact with the select state Medicaid programs managing contracting pull through with quality managers.
  • Attend conferences and physician meetings related to Medicaid payers, and provide expertise to the Market Access team and internal stakeholders.
  • Take responsibility to coordinate state enrollments, reenrollments, and coverage designations for preventive medicine and Exact Sciences products.
  • Responsibilities may include Medicaid pull through with capitated groups and contracting with such entities, including entities that provide for under-served populations.

Qualifications

Minimum Requirements

  • Bachelor’s Degree
  • 5 years of experience in any of the following areas: contracting and coverage with large national payers and/or Medicaid health plans, sales leadership in biotech, device or diagnostic laboratory companies, or extensive experience working in government health plans or state programs.
  • Extensive knowledge of State Medicaid programs in pharma, lab, biotech, and/or device. 
  • Must be willing to travel at least 75% within designated region and some travel outside of region as needed for national leadership meetings
  • Must possess a valid driver's license, have no more than 2 moving violations in the past 36 months, and have no unresolved revocation or suspension issues.
  • Candidate needs to reside in assigned geography. 

Desired Characteristics

  • Possess a solid understanding of the molecular diagnostic testing market: products, companies and technology.
  • Best, demonstrated track record of developing and managing complex negotiations with multiple decision makers.
  • Outstanding problem solving, project and program management skills.
  • Ability to develop a value proposition and effective business case that will influence medical policy and coverage decisions.
  • Ability to present clinical data, scientific findings and complex information in a persuasive manner to a variety of audiences.
  • Proven, effective time management, expense reporting, prioritization and delegation skills.
  • Effective English communication skills, both written and verbal
  • Outstanding influencing, interpersonal and networking skills to drive successful relationship building.
  • Effective presentation skills; able to present ideas to customers in a way that produces understanding and impact.
  • Existing relationships with individuals at insurance companies and a variety of payer organizations, state, commercial, and Medicaid organizations
  • Experience field sales team management preferred, specialty markets strongly preferred.
  • Able to work independently with little direction, capacity to research and stay current on managed care and healthcare industry trends focusing on underserved populations.
  • Possess a solid understanding of the molecular diagnostic testing market: products, companies and technology.
  • Demonstrated track record of developing and managing complex negotiations with multiple decision makers.
  • Outstanding problem solving, project and program management skills.

EEO Disclosure

Exact Sciences is an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to age, color, creed, disability, gender identity, national origin, protected veteran status, race, religion, sex, sexual orientation, and any other status protected by applicable local, state or federal law. The Company’s affirmative action program is available to any applicant or employee for inspection upon request. 


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