Senior Director, Pipeline Management

Foundation Medicine, Inc.
Full Time
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.
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.
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; Minimum 5 years of people management experience

Financial modeling for reimbursement strategy and business case development
MBA or advanced degree (M.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 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
Deep expertise in molecular diagnostics coding (CPT, HCPCS) and billing regulations (Medicare, Medicaid, commercial payers).
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.
Understanding of HIPAA and importance of patient data privacy
Commitment to reflect Foundation Medicine's values: 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
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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