The Medicaid Policy and Reimbursement Manager I, Market Access is an individual contributor position. The role will fully support all policy and reimbursement efforts directed towards state and managed Medicaid plans. The role will focus on expanding coverage, improving reimbursement and expanding in-network contracting efforts across the Medicaid landscape for Natera family of products, under the direction of Director for Government Affairs and Contracting.
- High-level vision to understand the healthcare and Medicaid environments, track changes that can affect future reimbursement and policy expansion
- Identify, assess and communicate key policy, reimbursement and contracting issues (including utilization management and prior authorization) that may have an impact on Natera product offerings for local and national Medicaid/Medicare plans
- Research and conduct analysis of the market in terms of coverage, reimbursement, trends, pricing, contracting strategies, and patient access.
- Expand policy and coverage of all products as needed, and utilize expanded markets as leverage with other states/commercial payers
- Improve claims adjudication/payment/ASP of various products via improvement of UM/PA requirements/restrictions, expanded coverage and increased rates for various key products
- Coordinate and attend trade shows and advisory boards if needed
- Additional responsibilities as required
- This role works with PHI on a regular basis both in paper and electronic form and has access to various technologies to access PHI (paper and electronic) in order to perform the job
- The employee must complete training relating to HIPAA/PHI privacy, General Policies and Procedure Compliance training and security training as soon as possible but not later than the first 30 days of hire.
- Must maintain a current status on Natera training requirements.
- The employee must pass post-offer criminal background check.
- 3-5 years of professional experience in billing, CPT coding, and reimbursement
- Fluency with managed care environment and key drivers of success in gaining reimbursement
- BS/BA or equivalent required; Masters/MBA preferred
KNOWLEDGE, SKILLS, AND ABILITIES:
- Strong analytical and technical ability, comfort with science and numbers, cost-effectiveness models
- Competitive and positive attitude, team player
- Excellent oral and written communication skills
- Strategic thinker and problem solver
- Healthcare billing and reimbursement experience
PHYSICAL DEMANDS & WORK ENVIRONMENT:
- Duties are typically performed in an office/home office setting.
- This position requires the ability to use a computer keyboard, communicate over the telephone and read printed material.
- Duties may require working outside normal working hours (evenings and weekends) at times.
- Some travel (minimal) required