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Aegis Sciences Corporation · 2 weeks ago

Director, Payer Policy Relations

Nashville, TN

Contract

Onsite

Director/Executive

10+ years exp

Aegis Sciences Corporation is seeking a Director of Payer Policy Relations to lead strategic engagement with payers and ensure policy compliance across various payer types. The role involves monitoring payer policies, managing reimbursement optimization, and facilitating collaboration across departments to enhance payer relationships and organizational goals.

BiotechnologyClinical TrialsHealth CareMedical

Responsibilities

Monitor and interpret payer policies and regulatory changes

Thoroughly research and analyze payer policies, guidelines, and regulations

Understand the nuances of different payer types (commercial, government, etc.) and their specific requirements

Ensure compliance with payer rules and regulations

Assist in the development of new or improved policies and processes to optimize reimbursement and patient access as well as evaluate the effectiveness of existing policies and processes and recommend changes

Identify and address reimbursement issues, including claim denials and payment delays

Develop strategies to improve reimbursement rates and reduce financial losses

Analyze data to identify trends in denials and develop appeals strategies

Analyze payer data to identify trends, measure the impact of policies, and develop and maintain reports and dashboards to track key performance indicators

Advocate for positive coverage decisions from payers, particularly for new or emerging technologies and treatments

Develop and present evidence-based materials to support coverage requests

Build and maintain relationships with key payer contacts and stakeholders

Collaborate with internal teams (e.g., government affairs, compliance, managed care, clinical) to align with payer engagement strategies

Communicate policy changes and updates to internal stakeholders

Collaborate with other departments (e.g., clinical, revenue cycle) to implement policy changes and improvements

Qualification

Payer relations experienceCPT coding expertiseICD-10 coding expertiseHCPCS coding expertiseReimbursement optimizationData analysisPayer portal knowledgeExcel proficiencyCommunication skillsOrganizational skillsCollaboration skills

Required

Bachelor's Degree in Business, Finance, or related discipline required

A minimum of 10 years of experience in payer relations, contracting, and/or revenue cycle leadership required

Deep expertise in CPT, ICD-10, HCPCS coding systems, and denials

Strong working knowledge of payer portals, appeals workflows, and EMR/LIS platforms

Exceptional analytical, organizational, and communication skills

Proficient in Excel and familiar with data visualization/reporting tools (Tableau, Power BI, or equivalent platforms)

Preferred

Experience in a laboratory or diagnostic testing environment is highly preferred

Company

Aegis Sciences Corporation

Founded in 1990, Aegis Sciences Corporation is a forensic toxicology and healthcare laboratory that provides science-driven drug testing and consulting services based in Nashville, TN.

Founded in 1991

Nashville, Tennessee, USA

501-1000 employees