The Position:The Market Access Operations Manager is responsible for the operational infrastructure that enables successful Market Access execution across Veracyte's diagnostic testing portfolio, including payer credentialing and enrollment, state Medicaid participation, contract implementation, and the system of record for all Market Access agreements and documentation.
Reporting to the Director, Market Access & Payer Relations, this individual will partner closely with Market Access, Reimbursement Operations (RCM), external consultants, Client Services, Finance, Legal, Compliance, Regulatory, and Commercial Operations teams to ensure payer contracting and coverage strategies are translated into accurate operational execution. The ideal candidate combines deep knowledge of healthcare reimbursement operations with a proactive, solutions-oriented mindset and a passion for improving patient access to innovative diagnostic testing.
Key responsibilities:- Lead all payer credentialing, re-credentialing, enrollment, and network participation activities across commercial payers, Medicare contractors, all state Medicaid programs and their associated managed care plans, laboratory benefit managers, and other reimbursement stakeholders. Own the end-to-end lifecycle, including initial applications, revalidation, roster and demographic updates, and ongoing maintenance requirements.
- Manage state-specific Medicaid enrollment requirements, including out-of-state laboratory enrollment where permitted, documentation and attestations, application fees, risk-level screening obligations such as fingerprinting and site visits, and subsequent contracting with Medicaid managed care plans once state enrollment is active.
- Manage federal government documentation, including SAM ID and associated opportunities, Federal Supply Schedule changes, FSS applications, and documents related to SBA plans, within required federal timelines.
- Coordinate ownership, control, and managing employee disclosures required by payer and government enrollment applications, working with Legal, Human Resources, Compliance, and executive leadership to gather and safeguard sensitive information.
- Maintain accurate laboratory, facility, and organizational records across payer systems and enrollment platforms, including NPPES and PECOS demographic data, NPI and taxonomy assignments, PTAN alignment, W-9 and remittance addresses, and payer directory listings.
- Partner with Regulatory and Quality to ensure CLIA certification and state clinical laboratory licenses and permits remain current, and align enrollment activities with state licensure prerequisites.
- Own the contract lifecycle after execution, including effective and termination dates, renewal and notice windows, amendments, and escalation of approaching deadlines to the contracting leads.
- Establish and maintain the system of record for market access documentation, including executed agreements and amendments, payer medical policies and coverage determinations, payer correspondence, and supporting evidence and dossier materials. Maintain version control, access permissions, and retention standards across document management, Customer Relationship Management (CRM), and Contract Lifecycle Management (CLM) platforms.
- Collaborate with Reimbursement Operations (RCM) teams to identify and resolve enrollment-related claim issues, reimbursement delays, and payer operational challenges, including those involving payer portals such as Availity.
- Develop and maintain standard operating procedures, process documentation, and operational controls related to enrollment, payer setup, contract administration, and reimbursement operations. Support related payer audits, credentialing reviews, and compliance requests.
- Select, implement, and administer enrollment tracking and contract repository systems, and manage credentialing vendors, external consultants, and third-party partners.
- Develop dashboards, reporting, and key performance indicators that measure operational performance, including enrollment cycle time by payer type, percentage of target Medicaid lives with active enrollment, on-time revalidation rate, denial dollars attributable to enrollment or configuration defects, and contract record completeness.
- Evaluate current workflows, identify opportunities for operational efficiencies, and execute process improvements through the effective use of automation and artificial intelligence (AI) tools.
- Manage group inboxes for payer correspondence and contracting communications.
Who You Are:- Bachelor's degree or equivalent combination of education and relevant experience.
- A minimum of 6 - 7 years of experience in healthcare reimbursement operations, payer credentialing, provider enrollment, managed care operations, revenue cycle, market access operations, or a related function.
- Demonstrated experience managing payer enrollment across both commercial and government payers, including hands-on multi-state Medicaid enrollment and revalidation.
- Working knowledge of enrollment systems and requirements relevant to facility and laboratory entities, including NPPES, PECOS, state Medicaid provider portals, and enrollment tracking platforms.
- Demonstrated ownership of a recurring compliance calendar such as revalidation, recredentialing, licensure renewal, or contract renewal, with a track record of preventing lapses.
- Experience administering contracts, fee schedules, or reimbursement documentation as a system of record, including version control and access management.
- Strong project management skills, including experience coordinating cross-functional initiatives involving reimbursement, billing, legal, compliance, finance, and commercial teams while managing multiple priorities, deadlines, and stakeholders.
- Experience developing and maintaining operational documentation, workflows, and standard operating procedures.
- Ability to manage sensitive personal and corporate information, including ownership and control disclosures, with a high degree of professionalism, accuracy, and confidentiality.
- Preferred Qualifications
- Experience supporting molecular diagnostics, genomic testing, laboratory developed tests (LDTs), precision medicine, oncology diagnostics, or other specialty diagnostic products.
- Experience enrolling an out-of-state laboratory in state Medicaid programs and navigating state-specific restrictions on out-of-state laboratory participation.
- Experience with Medicaid managed care plan contracting and roster processes as distinct from state fee-for-service enrollment.
- Experience with credentialing and contracting in VA and DoD facilities.
- Experience implementing or administering an enrollment tracking platform or contract lifecycle management system.
- Certified Provider Credentialing Specialist (CPCS) or similar credentialing certification.
- Familiarity with Medicare coverage, commercial payer operations, laboratory benefit managers, and diagnostic reimbursement pathways.
- Experience working with healthcare compliance, audit readiness, and credentialing governance processes.
#LI-Hybrid
The final salary offered to a successful candidate will be dependent on several factors that may include but are not limited to years of experience, skillset, geographic location, industry, education, etc. Base pay is one part of the Total Package that is provided to compensate and recognize employees for their work, and this role may be eligible for additional discretionary bonuses/incentives, and restricted stock units.
Pay range
$100,000-$135,000 USD
What We Can Offer YouVeracyte is a growing company that offers significant career opportunities if you are curious, driven, patient-oriented and aspire to help us build a great company. We offer competitive compensation and benefits, and are committed to fostering an inclusive workforce, where diverse backgrounds are represented, engaged, and empowered to drive innovative ideas and decisions. We are thrilled to be recognized as a 2024 Certified™ Great Place to Work® in both the US and Israel - a testament to our dynamic, inclusive, and inspiring workplace where passion meets purpose.
