Director, Private Payer Strategy & Contracts

C2N Diagnostics; United States; On-site; USD 180,000 - 240,000; Full time

Job summary

C2N Diagnostics is seeking a National Account Director, Private Payers to lead payer strategy and secure robust reimbursement for our diagnostic products. You will negotiate contracts, analyze reimbursement economics, and guide internal teams on payer policies and strategies.

The role requires deep knowledge of CPT coding, test reimbursement, and appeals processes across commercial payers, with a focus on molecular diagnostics and advanced testing.

Qualifications

• Bachelor's degree in Healthcare Administration, Business, Life Sciences, or a related field.
• Minimum of 10 years of experience in payer relations and payer contracting within a laboratory, diagnostics, or specialty testing environment.
• Demonstrated successful experience negotiating contracts with national and regional commercial health plans.
• In-depth knowledge of CPT coding, reimbursement methodologies, and coverage policies specific to laboratory and diagnostic testing.
• Strong understanding of the appeals and grievance process for commercial payers.
• Proficiency in payer data analysis and revenue cycle reporting tools.

Responsibilities

• Develop and execute payer strategies to secure in-network contracts and favorable reimbursement rates with commercial insurers.
• Lead contract negotiations with private payers, including rate structures, coverage terms, and value-based arrangements.
• Analyze payer fee schedules, benchmark reimbursement against market data, and identify opportunities to improve contracted rates.
• Maintain and manage a comprehensive payer contract database, tracking key terms, expiration dates, and renegotiation timelines.
• Ensure contract proposals comply with C2N’s goals and objectives as well as company policies and procedures; provide direction on methodology to evaluate proposals.
• Monitor and interpret payer medical policies, LCDs, and NCDs affecting specialty diagnostics.
• Develop and submit clinical evidence dossiers, medical necessity arguments, and coverage request letters to payers to obtain or expand coverage.
• Engage payer medical directors and policy teams to advocate for evidence-based coverage of specialty diagnostic services.
• Stay current on evolving payer policies for molecular diagnostics, genomics, and specialty testing categories.
• Oversee management of commercial payer denials, ensuring timely appeals utilizing clinical evidence, coding rationale, and contract provisions.
• Analyze denial trends by payer, test type, and denial reason to identify systemic issues and implement corrective actions.
• Collaborate with billing, coding, and clinical teams to reduce claim denials and optimize clean claim rates.
• Provide payer intelligence and reimbursement guidance to support new test launches, including CPT code selection.

Skills

Strategic thinking

Payer data analysis

Relationship management

Negotiation

Cross-functional collaboration

Education

Bachelor's degree in Healthcare Administration, Business, Life Sciences, or related field

Job description

C2N Diagnostics is seeking a National Account Director, Private Payers to lead payer strategy and secure robust reimbursement for our diagnostic products. You will negotiate contracts, analyze reimbursement economics, and guide internal teams on payer policies and strategies.

The role requires deep knowledge of CPT coding, test reimbursement, and appeals processes across commercial payers, with a focus on molecular diagnostics and advanced testing.