KEY RESPONSIBILITIES• Develop and execute strategic payer account plans that expand coverage, contracting, and reimbursement for Baylor Genetics testing, with priority emphasis on WGS-first policies.
• Establish trusted, value-based partnerships with national and regional commercial health plans, Medicare Advantage organizations, Medicaid and Managed Medicaid plans, integrated delivery networks, and other risk-bearing entities.
• Lead payer negotiations that translate clinical and economic value into favorable coverage policies, fee schedules, network agreements, value-based arrangements, and administrative pathways.
• Create payer-specific value propositions that connect WGS-first testing to improved diagnostic yield, earlier clinical decision-making, reduced serial testing, fewer avoidable procedures, and lower total cost of care.
• Partner with HEOR, Medical Affairs, Clinical Affairs, Product, Finance, Revenue Cycle, and Commercial teams to develop evidence strategies, budget-impact models, cost-offset analyses, real-world evidence, and payer-facing value dossiers.
• Lead collaborative payer initiatives, pilots, and evidence-development partnerships that quantify net health outcomes, utilization impact, patient journey improvements, and cost savings associated with WGS-first coverage.
• Secure positive medical policies and reduce restrictive prior authorization, documentation, coding, and reimbursement barriers.
• Monitor payer policy, reimbursement, competitive, and regulatory trends and convert insights into actionable account strategies and executive recommendations.
• Maintain accurate account plans, opportunity forecasts, contracting milestones, risks, decisions, and next steps within established business systems.
• Represent Baylor Genetics at payer medical-policy reviews, value-evidence meetings, industry forums, and cross-functional executive discussions.
Core Deliverables• Value-based payer partnership strategy and prioritized account plans.
• WGS-first payer value narrative supported by clinical utility, HEOR, and real-world evidence.
• Coverage-policy submissions, contracting proposals, value dossiers, and budget-impact materials.
• Payer pilots and collaborative evidence-generation initiatives with defined measures, milestones, and decision criteria.
• Executive reporting on covered lives, contracted lives, reimbursement performance, pipeline progress, risks, and expected financial impact.
Key Success Metrics• Growth in covered commercial, Medicare, Medicaid, and Managed Medicaid lives.
• Number and quality of positive WGS-first and portfolio coverage-policy decisions.
• Increase in contracted payer lives and favorable reimbursement arrangements.
• Payer partnerships, pilots, and HEOR collaborations launched and completed against defined milestones.
• Demonstrated evidence of improved net health outcomes, reduced diagnostic utilization, shorter time to diagnosis, or total-cost-of-care savings.
• Reduction in payer denials, prior-authorization friction, and administrative barriers.
• Achievement of annual market access, contracting, reimbursement, and revenue objectives.
• Accuracy of account forecasts and timely execution of strategic account plans.
QUALIFICATIONSRequired• Bachelor's degree in Life Sciences, Business, Healthcare Administration, Public Health, Health Economics, or a related field.
• 14+ years of progressive experience in market access, payer strategy, reimbursement, managed care contracting, HEOR, or molecular diagnostics.
• Demonstrated success securing payer coverage, negotiating contracts, improving reimbursement, or building value-based payer partnerships.
• Working knowledge of commercial, Medicare, Medicaid, and Managed Medicaid coverage and reimbursement pathways.
• Ability to interpret and communicate clinical utility, health-economic, real-world evidence, budget-impact, and total-cost-of-care analyses to payer audiences.
• Executive-level communication, negotiation, deductive storytelling, and cross-functional influence skills.
• Ability and willingness to travel approximately 40% domestically.
Preferred:• MBA, MPH, MHA, MS, PharmD, PhD, or equivalent advanced degree.
• Experience in genomics, molecular diagnostics, rare disease, oncology, reproductive genetics, women's health, WGS, or WES.
• Established relationships with national and regional health plans, payer medical directors, policy teams, and contracting leaders.
• Experience designing or executing HEOR studies, budget-impact models, real-world evidence programs, value dossiers, or payer pilots.
• Experience advancing WGS-first or comprehensive genomic testing coverage strategies.
COMPETENCIES✓ Strategic Payer Leadership ✓ Value-Based Partnership Development
✓ HEOR & Evidence Translation ✓ Contracting & Negotiation
✓ Executive Presence & Influence ✓ Cross-Functional Collaboration
✓ Financial & Data Acumen ✓ Accountability & Execution Excellence
✓ Innovation & Change Leadership ✓ Patient Access Orientation
PHYSICAL DEMANDS AND WORK ENVIRONMENT- Location: Remote
- Physical demands for the job (e.g., Must be able to lift 25 lbs, standing for prolonged periods of time, etc.)
- Work environment required for the job duties (e.g., Exposure to laboratory chemicals, etc.)
- Travel Requirements
- Special conditions (e.g. lab/clinical requirements if applicable)
- Approx 40% domestic Travel
