Market Access Manager, Consulting-Diagnostics
22 hours ago
Washington
Job DescriptionDescription: About Us ADVI Health is a leading healthcare and life sciences strategic consulting partner. We solve complicated problems with data-informed commercialization, market access, and policy expertise. Based in Washington, DC and Austin, TX, the company delivers insight- and data-informed advice and vision for leaders in healthcare business and policy. ADVI offers a comprehensive perspective by integrating business, policy, and science to find creative solutions through data, learned insight, and compelling strategy to help clients make decisions across all healthcare segments. We represent a sophisticated client base of Fortune 500 life sciences and healthcare service companies and venture and private equity-backed companies in biotechnology, diagnostics, digital health, AI, health IT, and healthcare services. ADVI is at the forefront of healthcare delivery transformation, payment reform, public and private payer coverage, and healthcare merger and acquisition deal flow within the US and abroad. For more information, visit advi.com. ADVI experts collaborate across ADVI's Solution teams to offer the right mix of services and expertise for our clients, including Federal and State Policy, Market Access, Reimbursement, and Strategic Analytics, Value and Economics (SAVEs). The team is highly regarded for our problem-solving ability, speed, depth of insight, and creativity. We are a collaborative team of consultants and advisors, all of whom are veterans of top healthcare and life sciences organizations, the federal government, state government, top consultants, nonprofits, commercial payers, or data and analytics companies. Our clients gain unparalleled access to expert consulting services and actionable data analytics, all tailored to meet their unique needs. We are often called upon to translate how the changing market landscape impacts the pharmaceutical industry, medtech, digital health, managed services, providers, and consumers. Join Us We are hiring Market Access Consultants for our growing Diagnostics team. As a member of the Diagnostics team, you will help drive the development and execution of sophisticated coding, coverage, and payment strategies to enable market access for laboratory diagnostic company clients. The person in this role will work directly with clients to support coding, coverage and reimbursement strategies. This is a great opportunity for someone with strong scientific communications skills and a passion for advancing market access for molecular diagnostics. Our Consultants are a trusted partner when it comes to Medicare payment analytics, claims data analysis, and navigating pathways for reimbursement strategy. This is an individual contributor role and reports to a division leader who is a renown expert in the field and who works directly with clients and the team. Responsibilities include: · 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. Requirements: · Bachelor’s degree required; advanced degree (MPH, MHA, MBA, MPP, MS Health Economics, or similar). · Genetic Counseling with Laboratory experience OR 1+ years of diagnostic company or consulting group experience. · Exposure to reimbursement programs and US market access strategy initiatives. · Knowledge of the molecular diagnostics and precision medicine sector’s payer requirements for coverage, payer coverage processes/timelines, payer reimbursement considerations, and existing payer policy. · 1-5 years of experience in reimbursement strategy, healthcare consulting, payer policy or market access. · 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. Location Candidates can be based anywhere in the U.S., with a preference for those operating in the Eastern or Central Standard Time Zone. Candidates based in Washington, DC or Austin, TX, will have the option of hybrid work arrangements. Compensation and Benefits The salary range is $112,000-$140,000 annual base salary plus incentive plan. Exceptionally qualified candidates will be evaluated according to experience levels. Please include your salary requirements with your application if they exceed the posted range. ADVI offers an outstanding benefits package, including the following: • 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 ADVI’s commitment to diversity, equity, inclusion, and collaboration is key to building extraordinary teams. We hire people with exceptional talents, abilities, and potential, then build an environment where you can become the best version of yourself. Our Vision To be the leading, go-to-market partner of choice for life sciences innovators worldwide. Our Mission To help our clients advance patient access, accelerate time to reimbursement, and achieve optimal business results by providing data-informed strategy and access solutions that create opportunity, generate evidence, optimize strategy, and fund growth. Our Values • Act with integrity, • Strive for excellence, • Stay curious, • Make an impact, • Invest in our community