Manager, Payer Access & Reimbursement

The Manager supports Payer Access & Reimbursement activities as a member of a cross-functional team, oriented to Medical Affairs (MA) activities related to medical access, evidence generation, value proposition creation, and coverage in policy, all of which impact the reimbursement of Quest’s portfolio of tests. This individual proactively brings expertise in the reimbursement of laboratory medicine to build and execute key strategic initiatives and decision points. The Manager supports the coordination of internal strategic and procedural activities related to enhancing third-party coverage and reimbursement of Quest products with emphasis on the Precision Oncology market. This individual must possess medical knowledge with strong analytic, problem-solving, decision-making and presentation capabilities to facilitate the coverage and reimbursement process as it relates to stakeholders’ interests, while mitigating risk for the organization. 

Responsibilities

1. Assist in the execution of Medical Affairs strategies aligned with business needs and the evolving external health system environment (private and government payers, regulatory environment) for optimal access, utilization, and reimbursement of Quest products.

   1. Identify opportunities to improve coverage and reimbursement (C/R) for assigned Payer Access category in all phases (e.g., idea to market, lifecycle management). 

   2. Support the execution and/or inform strategies based on root causes of denials.

   3. Evaluate coverage landscape and focus on clinical utility.

2. Leverage and coordinate internal/external stakeholders and resources to identify and address C/R opportunities. 

   1. Collaborate with cross-functional teams (e.g., other MA teams, Clinical Discipline Specialists/Clinical Franchises, Health Plans, Billing, Coding/Compliance/Legal) to develop Payer Access strategies to optimally support business needs.

3. Collaborate with other internal Quest teams as needs arise. Maintain knowledge of all assigned disease states, products, relevant changes in medical and reimbursement policies, and changes in payer procedures.  Ensure incorporation into the short and long-term business plans.

4. Performs other functions of the MA department as needed.

Qualifications

Required Work Experience:

• 4+ years experience between the following:

  • Medical knowledge and healthcare experience (e.g., Laboratory, Clinical, Health Systems, Genetics, Molecular, Health Plan)

  • Market Access experience with Precision Oncology testing

  • Payer policy/claims procedures (e.g., medical/reimbursement policy, billing and coding) 

Preferred Work Experience:

• 6 years’ experience between the following:

  • Clinical experience in hereditary cancer, oncology and emerging Oncology Markets

  • Payer policy/claims procedures (e.g., medical/reimbursement policy, billing and coding) 

  • Laboratory medicine (e.g., Clinical Laboratory Scientist/Medical Technologist, cytotechnologist, microbiologist, molecular variant scientist, laboratory genetic counselor)

Physical and Mental Requirements:

• Ability to execute concurrent projects

• Adaptable to abrupt changes in projects based on external influences/internal business needs 

• Strategic mindset - natural problem-solver

• Communication

Knowledge:

• In-depth knowledge of medical terminology and medical conditions

• Demonstrated understanding of the healthcare, health insurance, Medicare/Medicaid, and regulatory environments.

Skills:

• Strong time management

• Strong written and oral communication skills

• Collaborative approach in cross-function team settings

• Intermediate-advanced skills in using Microsoft™ Word, Excel, and PowerPoint software packages. Intermediate-advanced skills in Smartsheet. Basic knowledge employing and familiarity with AI platforms. 

Education:

• Bachelor’s degree in relevant discipline (e.g., Life Sciences, health/public policy, Laboratory Medicine) (Required)

Work Requirements:

• Travel Required approximately 20%