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ADVI Health · 1 month ago

Market Access Manager, Consulting-Diagnostics

Washington, DC

Full-time

Hybrid

Senior Level

$112K/yr - $140K/yr

5+ years exp

ADVI Health is a leading healthcare and life sciences strategic consulting partner. They are seeking a Market Access Manager to drive the development and execution of coding, coverage, and payment strategies for laboratory diagnostic clients, while collaborating with clients on reimbursement strategies and navigating complex market access challenges.

ConsultingHealth Care

Responsibilities

Working directly with clients to execute and report on project deliverables, as directed by the project leader

Creates client ready or nearly-client ready deliverables clearly communicating complex research findings

Understanding policies, legislation and regulations relevant to molecular diagnostics and all things reimbursement

Works independently to complete specific components of research and analysis to support project delivery

Works independently to deliver high quality, complex research within expected timelines

Analyzes industry reports, publications, policy proposals, legislation, and regulations to increase knowledge of industry trends and market changes

Ability to multi-task across multiple projects, creating maximum leverage while effectively balancing project priorities and delivering quality

Work with large datasets (e.g., Medicare claims, encounter data, PDE files, plan benefit package data) to generate insights and identify market trends

Build, maintain, and improve quantitative models, forecasts, and payment simulations to evaluate policy changes and payment system impacts

Conduct descriptive and comparative analyses of enrollment, utilization, quality measures, and reimbursement rates. Track CMS rulemaking, legislation, and regulatory changes related to Medicare Advantage, Part D, and other federal programs

Summarize key policy and payment updates for internal and client teams

Support senior staff in translating regulatory developments into client-facing insights

Conduct descriptive and comparative analyses of enrollment, utilization, quality measures, and reimbursement rates

Build, maintain, and improve quantitative models, forecasts, and payment simulations to evaluate policy changes and payment system impacts

Conduct comprehensive reviews of CMS, MAC, and commercial payer policies, legislative proposals, and coding/payment updates (e.g., CPT®, HCPCS, ICD-10, DRG)

Analyze claims data, policy documents, and payment files to identify trends and implications for client strategy

Develop coding roadmaps, coverage strategies, and payment modeling to support client product launches and lifecycle management

Provide guidance on coding applications (CPT®, HCPCS Level II), payment rate-setting methodologies (PFS, OPPS, APCs), and coverage pathways (LCD/NCD development, commercial payer adoption)

Collaborate with internal and external teams to align reimbursement strategy with regulatory, market access, and commercial objectives

Qualification

Reimbursement strategyHealthcare consultingMarket access strategyCPT/HCPCS codingData analysisQuantitative modelingProject managementScientific communicationAttention to detailCollaboration

Required

Bachelor's degree required; advanced degree (MPH, MHA, MBA, MPP, MS Health Economics, or similar)

5+ years of experience in reimbursement strategy, healthcare consulting, payer policy or market access work in a medical device company or consulting group

Experience with reimbursement programs and US market access strategy initiatives for diagnostics, precision medicine or companion diagnostic products

Knowledge of the medical device payer requirements for coverage, payer coverage processes/timelines, payer reimbursement considerations, and existing payer policy

Experience with CPT/HCPCS coding, CMS payment systems, and payer engagement is highly desirable

Familiarity with key data sources for healthcare analysis including Medicare claims, Medicare Part D, Medical Expenditure Panel Survey (MEPS) data, or Medicare Current Beneficiary Survey (MCBS) data

Understanding of coding systems, payment methodologies, payer policy processes, and coverage decision-making frameworks

Excellent project management skills, able to execute multiple client deliverables under tight deadlines

Exceptional attention to detail and commitment to producing high-quality, client-ready work

Benefits

Medical, dental, and vision

8 paid holidays, plus one ADVI Anniversary Day per calendar year

401(k) retirement contribution match, up to 3 percent of salary, with immediate vesting

Health Reimbursement Account

Life and short-term and long-term disability insurance; and

Paid vacation and sick leave

Company

ADVI Health

ADVI offers expert advice and influential solutions, informed by data and guided by a clear vision of the complex intersection of life sciences and healthcare innovation, economics, policy, and patient impact.

Founded in 2000

Washington, District of Columbia, USA

51-200 employees