Payer Policy and Reimbursement Specialist

Are you ready to make a real difference in the field of cancer diagnostics? Join a leading-edge clinical lab dedicated to transforming the diagnosis and treatment of brain and spinal cord tumors. We are on a mission to serve patients and healthcare providers, using our advanced cerebrospinal fluid testing platform. By employing next-generation sequencing, we offer innovative solutions that provide crucial insights for clinical decision-making.

We are seeking a dynamic and motivated Payer Policy and Reimbursement Specialist to join our rapidly expanding team. This is your chance to be part of a passionate, fast-paced environment where your contributions will help shape the future of cancer diagnostics. With ample room for career advancement, this role offers an exciting opportunity for growth.

Location: Onsite - Chicago, IL

Employment Type: Full-time

Compensation: Base Salary $120k-$160k Annually

Role Overview: As a Payer Policy and Reimbursement Specialist, you will be the key driver in optimizing payer policy, health economics, reimbursement strategies, and payer adoption of our innovative products. Reporting to the SVP of Market Access, your role will involve:

• Building and maintaining strong scientific and clinical relationships with stakeholders.
• Communicating the clinical, economic, and quality of life value of our product portfolio to payer stakeholders.
• Developing strategic alliances or collaborations to drive evidence generation and value-based revenue opportunities.
• Analyzing data and guiding research initiatives to support value-based reimbursement strategies.

Key Qualifications:

• Minimum of 5 years’ experience with payers in medical policy development for advanced molecular diagnostics.
• Understanding of revenue cycle management processes, including prior authorizations and appeals.
• Advanced healthcare degree (PhD, PharmD, RN, MS, CGC, etc.).
• Exceptional scientific writing skills for producing manuscripts and medical documents.
• Proven ability to articulate complex medical and scientific concepts to payers.
• Strong relationship-building skills with various payer-related organizations.
• Experience in project management, especially in clinical trials or payer-related projects.
• Willingness to travel up to 30% of the time.

Responsibilities:

• Support reimbursement processes, including prior authorizations and appeals.
• Define and communicate the clinical and economic value of products compared to standard care.
• Engage with health technology assessment and professional guideline organizations to enhance product assessments.
• Formulate strategic payer alliances and drive evidence-based market access initiatives.
• Lead marketing efforts focused on payer stakeholders and reimbursement audiences.
• Assist in designing clinical utility and health economic studies and author related publications.
• Collaborate across teams to ensure cohesive messaging for payers.

Join us and be part of a mission-driven company that is dedicated to reshaping the landscape of cancer diagnostics. Apply now and contribute to a cause that truly matters!