Director, Market Access

This is a fully remote position, open to applicants in United States.

📋 Description

• Develop and implement strategic payer account plans to enhance coverage, contracting, and reimbursement for Baylor Genetics testing, focusing on WGS-first policies.

• Build value-driven partnerships with commercial health plans, Medicare Advantage organizations, Medicaid and Managed Medicaid plans, integrated delivery networks, and other risk-bearing entities.

• Direct payer negotiations regarding coverage policies, fee schedules, network agreements, value-based arrangements, and administrative pathways.

• Craft payer-specific value propositions that link WGS-first testing to improved diagnostic yield, expedited clinical decision-making, minimized serial testing, fewer unnecessary procedures, and reduced overall care costs.

• Collaborate with HEOR, Medical Affairs, Clinical Affairs, Product, Finance, Revenue Cycle, and Commercial teams on evidence strategies, budget-impact models, cost-offset analyses, real-world evidence, and payer-facing value dossiers.

• Spearhead payer initiatives, pilots, and evidence-development partnerships that assess health outcomes, utilization impact, patient journey enhancements, and cost savings.

• Achieve favorable medical policies and mitigate prior authorization, documentation, coding, and reimbursement challenges.

• Keep track of payer policy, reimbursement, competitive, and regulatory trends, providing account strategies and executive recommendations.

• Maintain account plans, opportunity forecasts, contracting milestones, risks, decisions, and next steps within business systems.

• Represent Baylor Genetics at payer medical-policy reviews, value-evidence meetings, industry forums, and executive discussions.

• Present payer partnership strategies, prioritized account plans, coverage-policy submissions, contracting proposals, value dossiers, budget-impact materials, payer pilots, evidence-generation initiatives, and executive reports.

⛳️ Requirements

• Bachelor’s degree in Life Sciences, Business, Healthcare Administration, Public Health, Health Economics, or a related field.

• Over 14 years of progressive experience in market access, payer strategy, reimbursement, managed care contracting, HEOR, or molecular diagnostics.

• Proven success in securing payer coverage, negotiating contracts, enhancing reimbursement, or establishing value-based payer partnerships.

• Familiarity with coverage and reimbursement pathways for commercial, Medicare, Medicaid, and Managed Medicaid.

• Capability to interpret and convey clinical utility, health-economic, real-world evidence, budget-impact, and total-cost-of-care analyses to payer stakeholders.

• Strong executive-level communication, negotiation, deductive storytelling, and cross-functional influence abilities.

• Willingness and ability to travel approximately 40% domestically.

• An MBA, MPH, MHA, MS, PharmD, PhD, or equivalent advanced degree is preferred.

• Experience in genomics, molecular diagnostics, rare disease, oncology, reproductive genetics, women’s health, WGS, or WES is preferred.

• Established connections with national and regional health plans, payer medical directors, policy teams, and contracting leaders are preferred.

• Background in designing or executing HEOR studies, budget-impact models, real-world evidence programs, value dossiers, or payer pilots is preferred.

• Experience in advancing WGS-first or comprehensive genomic testing coverage strategies is preferred.

🏝️ Benefits

• Equal opportunity employer dedicated to creating an inclusive and diverse workplace.

• Application process accommodations available through Human Resources.