Payer Account Director - Southeast

🕒 29 days ago

📍 Worldwide - Remote🎸 Senior 🧑‍💼 Account Manager 💼 Full-Time

Payer StrategyPayer AccessHealthcare ReimbursementPayer Case Rates

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📜 Description

Serve as the payer-access point of contact for Authorized Treatment Centers, including onboarding.
Develop and execute strategies for regional and national payers, state Medicaid agencies, and Medicare Administrative Contractors.
Present scientific, clinical, and economic evidence to support product value propositions and engage payer decision-makers.
Partner with academic hospitals and health systems to support patient access, and work with Case Management to resolve access issues.
Track market-access KPIs and maintain accurate dashboards.

🛠️ Requirements

Bachelor’s Degree
12+ years related Payer/Hospital reimbursement experience in the healthcare industry
Proven relationships with Commercial Payer Medical Directors, Medicare Part A, State Medicaid, and Managed Medicaid stakeholders
Strong analytical skills with experience in Payer Case rates, Payer policy development, and Payer Policy data tracking tools
Problem solving skills and multi-tasking experience are critical
Proactive, results-oriented, collaborative, self-starter with demonstrated strong leadership skills and experience in a complex reimbursement environment
Excellent presentation skills, both written and verbal
Knowledge of regulations and laws governing the protection of patient identifying information, OIG, FDA, and CMS policies pertaining to access
Must be a true team player and work collaboratively with key internal stakeholders
High level of proficiency in Microsoft Excel, Word and Power Point is required

✨ Benefits

Pre-IPO equity
Annual bonus
Medical benefits
Dental benefits
Vision benefits
401(k) plan
Life and accidental death and disability coverage
Payer medical policies
Reimbursement across the product portfolio

Full job description

Position Summary: We are seeking a highly motivated individual to join our US Payer Field team (Market Access) as an Account Director, covering the Southeast US. Key states include FL, GA, TN, KY, WV, NC, SC, AL, OK, MS, AR, LA, and part of TX. Key desired payer relationships include Aetna, FL Blue, and regional payers in these states.

The primary objective of the Payer Account Director is to secure favorable coverage and reimbursement for all Orca Bio products through regional, national, and government payers. Account Directors are responsible for formulating and executing account plans engaging with both Regional and National Payer customers and working directly with targeted Academic Hospitals/Health Systems. In collaboration with field sales team members, this role will be integral to onboarding treatment centers and supporting broad, timely patient access. The Account Director will be a subject matter expert on all access related items including payer policy, pricing communication, and authorized treatment center reimbursement. Strong collaboration skills are a must as this role will require you to engage with several cross-functional teams including Field Sales, Medical Affairs, Legal, Quality, and Marketing, as required.

More than one million people in the United States today are fighting blood cancer. While a traditional allogeneic stem cell transplant has been the best hope for many, the transplant itself can prove fatal or lead to serious conditions, such as graft vs. host disease. Orca Bio is a commercial-stage biotechnology company redefining the transplant process by developing next-generation cell therapies with the goal of providing significantly better survival rates with dramatically fewer risks. With our purified, high-precision cell therapies we hope to not only replace patients' blood and immune systems with healthy ones, but also restore their lives. The anticipated annual salary range (listed above) for this job is based on prior experience in the role/industry, education, location, internal equity, and other job-related factors as permitted by law. For remote-based positions, this range may vary based on your local market. Full-time employment positions will also be eligible to receive pre-IPO equity and annual bonus, in addition to competitive medical, dental, and vision benefits, PTO, 401(k) plan, life and accidental death and disability coverage, and parental leave benefits. Other perks include subsidized daily lunches and snacks at our on-site locations. Who we are We are driven by a passion for science and compassion for patients. We act with urgency to ensure our treatments are one day accessible to all who need them. We live by our core values of passion, courage, and integrity. Excellence in our work means the chance to unlock a better quality of life for our patients, and with that comes tremendous responsibility. We innovate on a path that hasn’t been paved. We embrace an entrepreneurial spirit and take calculated risks to achieve our mission. We aren’t afraid to ask “why not” and challenge the status quo. We maintain a start-up culture of camaraderie and leadership by example, regardless of title. We’re proud to be an equal opportunity employer, and recognize that celebrating our differences creates stronger, lasting solutions that better serve our team, our patients and their healthcare providers. Notice to staffing firms Orca Bio does not accept resumes from staffing agencies with which we do not have a written agreement and specific engagement for a particular opening. Our employment activities, inquiries and offers are managed through our HR/Talent team, and all candidates are presented through this channel only. We do not accept unsolicited resumes, and we rarely outsource recruitment.

Key Responsibilities

Serves as single-point-of-contact for all Authorized Treatment Centers (ATCs) with respect to field-related payer-access engagements (including onboarding) as identified by Orca Pod

Develop and execute Payer Strategy for assigned regional and national payer accounts, state Medicaid agencies, and Medicare Administrative Contractors to secure access to Orca products, as well as on-going payer segmentation and business strategy tactics

Present analysis of scientific data, clinical practice goals, guidelines, and anticipated economic program outcomes to support product value proposition

Utilize clinical expertise of Medical Science Liaisons or medical providers in delivering comprehensive product and disease state presentations to key decision makers.

Deliver and maintain favorable access, advantageous payer medical policy, and appropriate reimbursement for Orca products at regional & national payer accounts throughout the life cycle management of Orca’s portfolio.

Accountable for partnerships with targeted Academic Hospitals/Health Systems to ensure patient access for Orca products on a case-by-case basis, as needed

Frequent interactions with Orca’s Case Management team to resolve patient access issues

Track KPIs and ensure accuracy of dashboards to measure account market access results

Must adhere to Orca Bioscience’s core values, policies, procedures, and business ethics.

Perform miscellaneous duties as assigned.

Required Qualifications

Bachelor’s Degree

12+ years related Payer/Hospital reimbursement experience in the healthcare industry

Proven relationships with Commercial Payer Medical Directors, Medicare Part A, State Medicaid, and Managed Medicaid stakeholders

Strong analytical skills with experience in Payer Case rates, Payer policy development, and Payer Policy data tracking tools

Problem solving skills and multi-tasking experience are critical

Proactive, results-oriented, collaborative, self-starter with demonstrated strong leadership skills and experience in a complex reimbursement environment

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