Payer Relations Manager

This is a fully remote position, open to applicants in Illinois, +5 more states.

📋 Description

• Identify, cultivate, and oversee strategic partnerships with payers and organizations that impact payer decision-making within the designated geographic region.

• Collaborate directly with the regional Market Access team, which includes sales, implementation, and billing specialists.

• Recognize and address payer-related challenges.

• Execute tactical plans devised by Market Access leadership.

• Provide competitive insights to leadership.

• Assist in formulating the local market access strategic plan for Heartflow’s FFRCT Analysis.

• Reduce FFRCT access obstacles and secure favorable coverage policies and reimbursement contracts.

• Take on and execute projects aimed at increasing covered lives and revenue.

• Stay informed about third-party reimbursement rules and regulations.

• Act as the primary contact for designated private payers.

• Mentor physicians on reimbursement advocacy.

• Lead discussions with payers to achieve positive coverage determinations and enhance payment contract terms.

• Negotiate, obtain, and manage regional contracts with payer accounts, managed care plans, ACOs, health systems, insurance companies, and potentially self-insured employers.

• Support the development of key opinion leaders and commercial-site access initiatives.

• Refine advocacy materials for physicians targeted at regional payers.

• Contribute to Medical Policy formulation.

• Assist in regional payer account strategy and tactics.

• Act as a liaison between payer customers and company personnel regarding administrative matters.

• Aid in the commercialization strategy alongside regional sales teams and participate in regional field sales plans.

• Build relationships with health plan medical directors, practice administrators, and key opinion leaders.

• Foster reimbursement confidence within the cardiovascular community.

• Implement the strategic and tactical reimbursement plan within assigned territories.

• Represent the company at trade shows, scientific meetings, and other relevant events as necessary.

⛳️ Requirements

• Proven experience in securing coverage decisions and negotiating contracted rates with commercial payers in the medical device or diagnostics sector (hospital contracting experience is advantageous).

• Comprehensive understanding of the global payer and reimbursement landscape, particularly concerning coronary artery disease diagnostic testing in the U.S.

• Strong knowledge of coverage, coding, payment, and reimbursement requirements and policies.

• Familiarity with key private payer policy infrastructure, payment methodologies, and trends in coding and coverage.

• Experience in developing physician advocates who can testify to the clinical benefits of Heartflow products.

• Demonstrated capability to collaborate effectively with multiple stakeholders.

• Experience working in the field to support the reimbursement needs of sales team members.

• Exceptional written and verbal communication skills, particularly in developing presentations.

• Ability and readiness to comply with regulatory requirements, including Heartflow’s quality system standards.

• A minimum of 5+ years of experience in the health care/managed care and reimbursement industry.

• A Bachelor’s degree is required.

• An MBA or advanced degree is preferred.

🏝️ Benefits

• Competitive salary and performance-based bonuses.

• Comprehensive health benefits, including medical, dental, and vision coverage.

• Opportunities for professional development and career advancement.

• Flexible work arrangements.

• A supportive and inclusive work environment.