National Account Executive, West

Responsibilities

• Meet access goals and ensure medical coverage pathways are consistent with FDA approved prescribing information
• Collaborate with Qualified Treatment Center (QTC) Account Liaisons, Marketing, Patient Support Team and Medical Value Liaisons and other Genetix stakeholders to identify access barriers and ensure patient access
• Implement strategies and tactics to support individual patient access and reimbursement (e.g., coverage, coding) across payer segments
• Serve as the primary, regional point-of-contact for Genetix's Qualified Treatment Center network for all market access-related issues. Proactively educate QTC around state Medicaid and commercial payer coverage criteria, PA process and requirements as well as addressing account specific educational gaps in our treatment process and pathway. Create confidence in the access pathway for our therapies by leveraging published medical policies and patient approvals across the QTC network and aligning all messaging to our market access engagement strategy
• Develop and maintain core relationships with the business functions at Genetix's QTCs with a focus on patient pull through, including but not limited to, managed care contracting, CFO and revenue cycle, government affairs, billing department leads, along with hospital quality and legal teams, gene therapy coordinators, financial coordinators and PA and appeals support
• Proactively work in a preventative measure with QTCs to establish hygienic PA submissions to alleviate incomplete submissions or administrative inaccuracies
• Consistently engage National and Regional commercial payers, FFS and Managed Medicaid plans, and Federal payers to positively influence decision makers in areas of clinical criteria and medical policy. Present, negotiate and execute Value Based Agreements (VBA) at the payer level to facilitate timely access to FDA-approved Genetix therapies
• Negotiate and manage value contracts with assigned payers for optimal Genetix product access
• Respond to ad hoc requests by small regional payers in assigned territory
• Work within the payer ecosystem to identify delays or friction in the approval process, develop a plan, and implement a timely resolution. Provide support and pull through strategies to the QTCs when to overcome delays within the process ex: PA requirements and any PA denials, distribution channel preference etc.
• Educate QTCs with Letter of Intent on considerations for case rate agreements to reduce delays. Connect QTCs with other QTCs for best practice sharing or connect them with appropriate decision makers at the health plan for issue escalation and resolution.
• Identify and leverage contacts within the payers and connect those payer stakeholders with the QTC to streamline PA review and approval processes
• Work cross-functionally within the POD team structure to ensure alignment across Genetix's stakeholders and that QTCs receive surround sound support at every step in the patient journey; these cross functional partners include: apheresis, patient support, field medical, legal and contracting, and working closely with the QTC account leads to mitigate and/or remove barriers to care at the consult and treatment phases of the patient journey.
• Work closely with Medical Value Liaison (MVL) in tandem for targeted situations e.g. PA prep, appeals, policy and coverage influence
• Share insights and feedback from across market access stakeholders (with a focus on payers and financial decision makers at QTCs)
• Encourage and facilitate QTC patient's enrollment into Genetix's patient support program Genetix Cares to enrich the patient treatment journey
• Maintain the utmost standard of professionalism and compliance in all internal and external engagements

Qualifications

• 10 years of experience in the biotech/pharma field with a bachelor's degree required; master's degree in a relevant health or finance related field preferred
• A track record of success engaging tertiary and quaternary clinical and research institutions and integrated delivery networks on market access issues
• Comprehensive understanding of the current and evolving US payer landscape within cell and gene therapies or complex therapies from a both medical and pharmacy benefit perspective
• Strong clinical aptitude/acumen
• Deep knowledge of U.S. markets and understanding of Commercial Payers, PBMs, Stop Loss and Reinsurance and Government Payers (FFS and Managed Medicaid, Medicare, and TRICARE)
• Established relationships with Pharmacy Directors, Medical Directors, and other key stakeholders with assigned accounts
• Demonstrated knowledge and specialty pharmacy and buy and bill procurement models across commercial and government payers; recent experience preferred
• Demonstrated expertise as a subject matter expert (SME) for assigned key payer accounts with experience in navigating complex vertically integrated orgs
• Experience negotiating and implementing outcomes-based or other alternative payment models preferred
• Exceptional customer business planning, tactical planning, and successful execution skills
• High degree of attention to detail including proven ability to manage multiple, competing priorities
• Travel 50%

Pay and benefits

The pay transparency range provided below is based on what we believe is a reasonable estimate for the base salary pay range for this job at the time of posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. This role is eligible for an annual bonus and long-term incentive. Actual base salary pay will be based on several factors, including but not limited to experience, skills, relevant education/qualifications, external market, internal equity, and other job-related factors permitted by law.

Genetix's total rewards package also provides employees with a comprehensive and competitive benefits suite to support a variety of employee needs. These benefits include comprehensive health, life and disability insurance, employer-matched 401(k) plan, lifestyle spending account, flexible time-off + paid holidays and winter holiday period, tuition reimbursement & loan repayment assistance, paid parental leave, paid onsite parking, commuter subsidy, and much more.