Manager, Managed Care & Payer Strategy

About Us

Inform Diagnostics, a Fulgent Genetics Company, is a nationally recognized diagnostics laboratory focused on anatomic pathology subspecialties including gastrointestinal pathology, dermatopathology, urologic pathology, hematopathology, and breast pathology.

Founded in 2011, our parent entity, Fulgent Genetics, has evolved into a premier, full-service genomic testing company built around a foundational technology platform.

Through our diverse testing menu, Fulgent is focused on transforming patient care in oncology, anatomic pathology, infectious and rare diseases, and reproductive health. We believe that by providing a wide range of effective, flexible testing options in conjunction with best-in-class service and support, we can redefine the way medicine is managed for patients and clinicians alike.

Since integrating with our therapeutic development business, Fulgent is also developing drug candidates for treating a broad range of cancers using a novel nanoencapsulation and targeted therapy platform. By merging our fields of expertise, we aim to become a fully integrated precision medicine company.

Summary of Position

The Manager, Managed Care & Payer Strategy will assist the Senior Director of Managed Care & Strategic Partnerships in creating and driving strategic contracting and payor partnership initiatives. This position will contribute to successful managed care relationships with focus on achieving increased utilization, supporting quality initiatives, ensuring compliance to contractual agreements, and establishing meaningful payor partnerships with assigned national and regional based payors. The Manager, Managed Care & Payer Strategy will be a strategic business partner, interfacing at the Director and Executive levels of the organization, providing leadership and taking ownership of the defined payor partners.

Key Job Elements

• Coordinates the contract lifecycle, including tracking contract approvals, coordinating wet or electronic signature, and implementation of final payor agreements in conjunction with Sr Director of Managed Care & Strategic Partnerships.
• Responsible for maintaining the contract administration database.
• Responsible for maintaining the Payor Contract Management System.
• Responsible for maintaining the Master Contract Tracking tool.
• Work closely and collaborate with internal team members as needed.
• Work closely with all assigned national and regional health plans.
• Manage the payment variance & health plan performance quarterly review process. To include reimbursement trends, market opportunities, contract performance, and market trends.
• Review contract terms and conditions to verify they are in compliance with company policies and all applicable federal and state regulations.
• Research regulations to guarantee contracts are updated and in compliance with laws.
• Provides training and guidance to Billing, Sales, and Ops on new contracts to ensure department readiness.
• Collaborates cross-functionally with RCM, Credentialing, Client Retention Team, Lab Operations, Marketing, and Sales Teams.
• Responsible for maintaining and researching health plan coverage policies as those relate to the business.
• Under the guidance of the Sr. Director of Managed Care & Strategic Partnerships: manage, negotiate, establish, and administer contractual agreements with a defined book of business inclusive of Fulgent Diagnostics, and it subsidiaries.
• Maintains confidentiality and performs duties in a responsible and ethical manner.
• Demonstrates curiosity to learn, agility, and flexibility as new projects are assigned.
• Support the Managed Care Team with project planning, issuing standard and ad-hoc reports.
• Travel as needed to assist the Managed Care department in trainings, presentations, conferences and payer-related meetings or negotiations.
• Performs additional duties as may be assigned.

Knowledge/Experience

• BA/BS degree in Healthcare Administration, Business, or related business field.
• Minimum five (5) years of healthcare experience is required; Laboratory healthcare preferred.
• Must have three (3) years working with healthcare contract terms, reimbursement methods, or managing a health plan book of business to include contract administration principles; and have basic contract language interpretation skills.
• Skills in project management including documentation, attention to detail, diligent follow-up, and organization essential.
• Excellent communication, especially written, and the ability to concisely summarize information.
• Demonstrated proficiency in Microsoft Word, Excel, Access, Power Point, Power BI, and Outlook are required.
• Excellent interpersonal skills including the ability to interact effectively and professionally with individuals at all levels; both internal and external.
• Exercises sound judgment in responding to inquiries; understands when to escalate inquiries.
• Self-motivated and capable of working independently, as well as part of a team.
• Must be able to manage multiple tasks/projects simultaneously within inflexible time frames. Ability to adapt to frequent priority changes and still meet required deadlines.
• Capable of working within established policies, procedures and practices prescribed by the organization.

Supervisory Responsibilities

• Yes

Reports to

• Senior Director of Managed Care & Strategic Partnership

Environment

Fulgent Therapeutics LLC is an Equal Employment Opportunity Employer.

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions. The term "qualified individual with a disability" means an individual with a disability who, with or without reasonable accommodation, can perform the essential functions of the position.

This job description reflects management's assignment of essential functions. Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time