Job Description

Foundation Medicine, Inc.

Full Time

About the Job

The Senior Director Payer Reimbursement and Pricing position involves assessing existing portfolio and new products reimbursement dynamics and commercial and government payer requirements to sustain and grow reimbursement for the Foundation Medicine product line. The position involves analyzing the competitor and CMS pricing and coding, to inform key reimbursement strategy components. This role also involves monitoring and assessing coding and pricing dynamics, collaborating with various departments including Payer Relations & Reimbursement (PRR), Market Access & Policy (MAP), Product, Clinical Development, Revenue & Access, and Sales and Marketing, in developing reimbursement strategies that reflect the company's goals.

This highly skilled individual will be able to manage the complex landscape of molecular diagnostics reimbursement throughout the different products lifecycle. The ideal candidate will combine strategic insight with a detailed understanding of coding, billing, and data analytics to optimize revenue and ensure compliance. This workstream leader is responsible for leading coding initiatives that will support premium pricing of our products within the Payer team pricing responsibility for Foundation Medicine. A key function of this role is to identify Medicare, Medicaid and Commercial Payer requirements, and create implementation strategies to support Foundation Medicine's Revenue Cycle Management functions. Job scope includes credentialing and re-credentialing Payers and Payer contract management. This role requires a visionary business leader, creative relationship builder, and strategic thinker who can ascertain what is needed to keep FMI ahead of the market.

This business growth-oriented leader, as a member of the Payer Leadership Team (PLT), will report to the VP HEOR, Market Access and Payer Strategy.

Key Responsibilities

• Perform thorough coding and pricing market landscape and competitor analyses on existing similar products to inform proper price positioning.
• Perform thorough market landscape and competitor dynamic analyses to inform the optimal pipeline product reimbursement pathways strategy.
• Develop and inform strong analytical plans defining the willingness-to-pay requirements of the government and key commercial payers.
• Master both the art and science of product pricing that incorporates the product attributes, competitive positioning and customer perceived value.
• Build fact-based pricing models supported with reliable-sourced market data, partner with new product launch team and act as the Voice-Of-Payer (VOP) in building the new product coding and pricing strategies.
• Communicate effectively the pricing proposals to relevant functions and gain timely buy-in.

Qualifications

Basic Qualifications

• Bachelor's degree in business or biosciences
• 10+ years of progressive pricing and coding experience in biotechnology, life-science industry or bioscience consultancy firms
• Professional coding experience is a must; certified coder is preferred.
• Minimum 5 years of people management experience

Preferred Qualifications

• Financial modeling for reimbursement strategy and business case development
• MBA or advanced degree (M.S., Ph.D.) preferred
• Current Certified Professional Coder (CPC) certificate
• Strong knowledge of the diagnostics' industry including competitors and market trends
• Experience working as a pricing analyst, with strong analytical and research skills
• Demonstrated history of positive, collaborative leadership on an organization's management team
• Proven track record of developing and executing effective pricing and coding strategies in the life sciences/diagnostics sector across a range of new product development and commercialization stages
• Demonstrated strategic thinking through examples of long-term strategy accomplishments and ability to implement positive change in a dynamic and growing organization
• Demonstrated success in leading and working collaboratively across multi-disciplinary teams in the development and execution of partnership commitments, ideally across multiple functional areas and development phases
• Deep expertise in building relationships with an established history of building and maintaining multi-level relationships at customer organizations
• Ability to work well under pressure while maintaining a professional demeanor
• Strong interpersonal skills that include excellent skills in written communication, oral communication, collaboration, and problem solving with other departments and colleagues
• Deep expertise in molecular diagnostics coding (CPT, HCPCS) and billing regulations (Medicare, Medicaid, commercial payers).
• Strong presentation skills.
• Strong knowledge of revenue cycle management and denial appeal processes.
• Proficient in analyzing, interpreting, and communicating data with the ability to work effectively both independently and in a team environment.
• Strong alignment with company's purpose, values and mission, and long-term goals.
• Excellent organization and attention to details and business priorities
• Understanding of HIPAA and importance of patient data privacy
• Commitment to reflect Foundation Medicine's values: Integrity, Courage and Passion.
• Preferred location is Boston, MA, working remote is also permissible with ability to travel up to 30% of the time.

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About Foundation Medicine

Confidence, or the belief that we need to check every box before applying for a job, can sometimes hold us back from going after a role that inspires us. At Foundation Medicine there's no such thing as the 'perfect' applicant, and our company is a place where every employee can make an impact and continue to grow whatever background they may have or path they may have taken. So, as long as you meet the basic qualifications for a role, please apply if you see a position that would make you excited to come into Foundation Medicine every day and help us transform cancer care.

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