Market Access & Payer Relations, Manager

About This Role

iRhythm is currently seeking an experienced Manager of Market Access & Payer Relations (MAPR) who will be responsible for ongoing strategic innovation, cross-functional collaboration, and the development and execution initiatives with payers in the Eastern United States. This role reports directly to the VP of MAPR and will partner with the Directors of MAPR to create and deliver Managed Market/Commercial and Market Access strategies that define and differentiate our health care services, demonstrate a patient-centered approach, and create long-term revenue stability through negotiating and maintaining preferential reimbursement terms with payers. We seek candidates who are passionate professionals with proven success in this field, who are dynamic leaders, networkers and influencers with strong communication skills, and are business collaborators with stakeholders both internal and external. This person will be responsible for driving growth in new business areas and devising creative solutions to overcome obstacles to facilitate patient access. Our work environment is fast paced, with a collaborative atmosphere. Most of all, we are passionate about delivering innovations that improve the quality of health care and the patient experience. We are looking for like-minded individuals to join our team today!

Essential Job Functions:

Contracting/Health Policy

• Develop strong and deep relationships with payer decision-makers in provider network, clinical management, utilization management, population health, and reimbursement operations.
• Facilitate and align internal team members and initiate engagement with their peers at various levels within each health plan account.
• Successfully negotiate credentialing applications with health plans and networks using a diverse range of techniques including value-based care concepts, and contracting best practices that provide iRhythm the foundation to achieve revenue/EBIDTA goals.
• Manage contractual relationships in the region, as delegated by the Directors of MAPR and ensure accurate administration of contract terms.
• Manage existing relationships with assigned payers, including fee schedules maintenance, coding updates, coverage, and payment information.
• Monitor payer utilization management / prior authorization requirements, as well as medical policies, and provide updates to the organization that impact our organization's referral network.
• Engage payers to remove restrictions that create barriers to iRhythm's health care services by providing evidence that supports our value and clinical superiority, either via negotiation or ongoing management via Payer internal processes.

Strategy and Pricing

• Execute payer strategies and credentialing with overall company direction and corporate goals.
• Work cross functionally with Government Affairs, Clinical, Market Access, Revenue Cycle, Enablement, Legal and Compliance as needed to execute strategy.
• Work collaboratively with Sales/Marketing to connect payer, provider, and related marketing strategies.
• Work with VP of MAPR and Directors of MAPR to analyze, evaluate and execute payer approach. Prioritize payer targets to maximize value for iRhythm.
• Proactively identify and recommend new growth opportunities (primarily within the payer community).
• Lead key meetings with customers to present our services value proposition.
• Will take part as one of the primary liaisons between iRhythm and payer organizations.
• Ensure that all Payer Relationships are managed in accordance with iRhythm standards.
• In collaboration with Market Access and Revenue Cycle Business Partners support regional sales management to quickly impact new high potential accounts and assure that billing and reimbursement issues are appropriately managed at the outset and that payer contracts are in place and effectively executed and maintained.

Operations

• Liaison with marketing and Market Access partners to create best of class support materials for field sales, payer advocates, and customer service.
• Provide market knowledge to assist in the development of physician advocacy, gather key data resources and/or acquire analytical tools necessary to better evaluate the effectiveness of customer messaging.
• Partner with Sales and Market Access Partners on value proposition discussions and develop messaging and tools that drive coverage and reimbursement growth and achieve overall financial goals.
• Identify and recommend appropriate operational changes to achieve maximum efficiency with payers.

Qualifications:

• Bachelor of Science required, or other life sciences preferred, from an accredited university or college with 8+ years overall experience.
• Minimum of 5 years' experience in medical device or pharmaceutical manufacturer preferred as well as experience with a Sales leadership background.
• 3+ years' experience in public or private third-party reimbursement arena or pharmaceutical/medical device industry in managed care, clinical support, or sales.
• Demonstrate functional understanding of National/local payer payment trends, the Insurance/Payer regulatory environment, policies, and relationships to assist product adoption and sales growth.
• Understanding of Medicare, Medicaid and commercial payer policies and processes.
• Demonstrated ability to work with multiple stakeholders in a collaborative and constructive manner.
• Demonstrated experience working with executive level groups within large health institutions to influence reimbursement coverage decisions.
• Experience negotiating and reviewing contracts preferred including rate negotiation, payment and operational terms, and value-based contracts.
• Possess a strong understanding of Commercial payers, Managed Care, Government and Federal payer sectors, coverage/billing/reimbursement policy.
• Experience with hospital/physician provider operations
• Knowledge and experience with CPT and ICD-10 coding.
• Strong written, verbal and presentation skills
• Strong customer service focus
• Self‐motivated and disciplined to meet deadlines for competing priorities and projects.
• Intermediate to advanced skills with Microsoft Office programs.
• Travel:
• Must be able to travel ~ 40-50% of the time.

What's In It For You

This is a regular full-time position with competitive compensation package, excellent benefits including medical, dental, and vision insurances (all of which start on your first day), health savings account employer contributions (when enrolled in high deductible medical plan), cafeteria plan pre-taxed benefits (FSA, dependent care FSA, commute reimbursement accounts), travel reimbursement for medical care, noncontributory basic life insurance & short/ long term disability. Additionally, we offer:

• emotional health support for you and your loved ones
• legal / financial / identity theft/ pet and child referral assistance
• paid parental leave, paid holidays, travel assistance for personal trips and PTO!

iRhythm also provides additional benefits including 401(k) (with company match), an Employee Stock Purchase Plan, pet insurance discount, unlimited amount of Linked In Learning classes and so much more!

FLSA Status: Exempt

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