National Market Access Manager

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

📋 Description

• Oversee all negotiations related to third-party payer contracts and other contract discussions with payers.

• Formulate, implement, and sustain a contracting strategy for the organization that considers current market trends and aligns incentives among companies within the Eurofins network.

• Manage and negotiate both national and regional contracts to ensure that the companies' goals are achieved promptly.

• Evaluate relevant contracts, associated documents, and proposed fees, negotiating the financial terms of contracts.

• Assess existing terms to determine if re-negotiation is necessary.

• Lead initiatives to petition payers for overturning negative coverage decisions or ensuring positive coverage for new tests.

• Act as the primary business owner and liaison for each third-party payer.

• Participate as a designated member of the Executive Leadership team for clinical companies that have third-party billing needs.

• Monitor, escalate, and summarize potential issues with contract provisions and regulatory matters concerning payer contracting to management.

• Collaborate with internal departments such as Payor Enrollment, Revenue Cycle, Analytics, Finance, Quality Management, and Legal.

• Build and maintain relationships with operational counterparts at payers and regulatory bodies on a national level.

• Work with external legal counsel to analyze and assess national and state payer market regulatory statutes.

• Assist in the development and upkeep of departmental policies and standard operating procedures, collaborating with team members in the Payor Relations department to ensure compliance.

• Create third-party tools to establish a Payor policy database specific to the tests conducted by Eurofins.

• Develop a dynamic fee schedule/reimbursement matrix and database.

• Address issues related to reimbursement and the interpretation of contract language with payers.

• Identify and pursue increased revenue opportunities through claims investigation, analysis of billing patterns, and engagement with billing and payer contractual non-compliance.

• Conduct data analysis from various data sources to refine the metrics used in measuring the effectiveness and return on investment of existing and new product activities.

• Model and generate payment analysis reports in Excel and other modeling software using SAS data obtained from our Xifin billing system.

• Monitor, identify, summarize, and maintain a repository of relevant regulatory and contractual requirements (e.g., No Surprise Bill state legislation, Medicare/Medicaid required contract language, etc.).

• Function as a project manager for assigned projects.

• Analyze and communicate necessary information to the managed care contracting department, billing, operations, and sales regarding any new WC, Auto, Medicaid, CMS, or health plan products introduced to the market.

⛳️ Requirements

• Bachelor’s degree in Business Administration, Finance, Accounting, and/or Information Systems is required.

• Master’s degree is preferred.

• Capability to lead a diverse team with various skill sets and age ranges.

• Strong interpersonal abilities; excellent written, verbal, and analytical skills; proficiency in meeting deadlines; commitment to delivering quality work on the first attempt.

• Minimum of 8 years of administrative experience in healthcare.

• Must be a self-motivated individual with the ability to organize and manage multiple tasks/projects to completion.

• Professional business acumen; in-depth understanding of payer reimbursement methodologies.

• Proficient in creating and utilizing MS Excel spreadsheets along with other MS Office applications, business intelligence tools, and/or other performance reporting programs.

• Experience with multiple state payers is preferred.

• Ability to process and comprehend complex information related to a managed care environment.

• Strong familiarity with managed care terminology and contractual provisions.

• Experience in compiling, coordinating, and analyzing regulatory requirements and contract language for payer contracts.

• Ability to maintain a high level of confidentiality regarding sensitive corporate information.

• Willingness to work outside of core business hours as necessary and take responsibility for issue resolution, regardless of the hours worked.

🏝️ Benefits

• Excellent full-time benefits, including comprehensive medical coverage, dental, and vision options.

• Life and disability insurance.

• 401(k) plan with company match.

• Paid vacation and holidays.