Director, Payer Contracting and Relationship Management

The Director, Payer Contracting and Relationship Management will be directly responsible for initiating and progressing contracting conversations with national and regional health plans. The Director will focus on signing contracts with high-priority payers to improve patient access and increase reimbursement. It will be necessary to rapidly scale national in-network coverage for Novocure patients, while ensuring contracting terms and rates align with Novocure’s financial and legal objectives.

 

The Director will also be tasked with renegotiating current payer contracts to maximize reimbursement and financial performance across Novocure’s service lines in collaboration with the Senior Director, Policy & Reimbursement. The Director will also be responsible for maintaining a working relationship with the payer contracting contacts.  This is an incredible opportunity to join a fast-growing, highly motivated team.

 

This is a full-time, exempt hybrid role with Mondays and Thursdays in the Portsmouth, NH office, reporting to the Senior Director, US Revenue Operations.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Initiate and progress contracting discussions with all national and regional health plans in collaboration with the Directors of Government and Commercial Reimbursement
• In collaboration with the Government Affairs and Policy team provide guidance on changes in reimbursement methodologies, as well as changes in state and federal legislation, to ensure that Novocure maximizes payer relations and maintains adequacy of payment for the services provided
• Manage existing contracts to optimize reimbursement, access, policy, and processes
• Responsible for the overall payer contracting process including establishing metrics to measure performance, monitoring of overall quality, determining priorities, and managing workflows
• Network with multiple departments within insurance companies to maximize relationships, contract terms, and growth opportunities
• Work with the payers to resolve and/or escalate contract and claims-related problems with health plans
• Identify or create tools, financial modeling systems or other resources to assist with payer contract evaluations
• Work closely with Novocure reimbursement, billing, and commercial teams to identify contracting and process improvement opportunities consistent with organization objectives
• Utilize your deep knowledge of payer behaviors and identify opportunities to troubleshoot payment issues with contracted payers
• Oversee and manage the team that negotiates single-case agreements for non-contracted payers
• Engage frequently with executive leadership to communicate progress and goals
• Renegotiate current payer contracts to improve reimbursement for Novocure while expanding our national reach in collaboration with the Senior Director, Policy and Reimbursement
• Collaborate with the Reimbursement teams regarding payer contracting issues and actively work with the payers to resolve these issues
• Collaborate with the Government Affairs and Policy team to develop prescriber billing and reimbursement strategies
• Work closely with local cross-functional teams, including Pricing, Government Affairs and Policy, Commercial, Medical, Finance, Legal, etc., to ensure successful reimbursement and coverage for all of Novocure’s service lines
• Collaborate with the Government Affairs and Policy team to understand the US market access and pricing landscape for DME products and supplement knowledge gaps by conducting market research
• Collaborate with the Government Affairs and Policy team to develop and implement coverage strategy, including coverage policy submissions and negotiations with commercial payers

 

QUALIFICATIONS/KNOWLEDGE:

Qualifications:

• Bachelor's degree in business, finance, or a related field is required. Master's degree is a plus.
• Proven experience as a contract negotiator or in a similar role.
• 7 - 10 years of progressive experience in ancillary payer contract negotiations or equivalent, preferably in the medical device field, DME, health insurance company, or medical background

 

Knowledge:

• Deep understanding of payer business models and economics
• Strong relationship-building skills and delight in forging meaningful bonds across all levels of an organization
• Thrive in ambiguity and seek opportunities to approach complex challenges, drive towards outcomes, and shape strategy
• Strong organizational skills and the ability to manage a robust payer contracting funnel efficiently
• Self-starter who seeks to innovate and improve processes in a fast-paced environment
• Passion for improving access to innovative technology in On