Payer Account Director - Southeast

Orca Bio; Town of Florida (NY); On-site; USD 250,000 - 285,000; Full time

Benefits offered by this job

Pre-IPO equity

Annual bonus

Medical insurance

Dental insurance

Vision benefits

PTO

401(k)

Life insurance

AD&D

Parental leave

Subsidized lunches

Job summary

Orca Bio seeks a seasoned Account Director for the US Payer Field team, covering the Southeast region. You will secure favorable coverage and reimbursement by engaging regional and national payers, academic health systems, and government programs.

You will collaborate with Field Sales, Medical Affairs, Legal, Quality, and Marketing to drive patient access. The role requires strong payer strategy, stakeholder management, and analytical presentation skills, with travel ~40%.

Qualifications

• Bachelor’s degree required.
• 12+ years payer/hospital reimbursement experience.
• Proven relationships with Commercial Payer Medical Directors, Medicare Part A, State Medicaid stakeholders.
• Strong analytical skills with payer policy data tracking tools.
• Proactive, results-oriented, collaborative leadership in a complex reimbursement environment.
• Excellent presentation skills, written and verbal.
• Knowledge of OIG, FDA, and CMS policies pertaining to access.
• Team player with cross-functional engagement.
• Proficient in Excel, Word and PowerPoint.
• Willingness to travel ~40%.

Responsibilities

• Serves as single-point-of-contact for Authorized Treatment Centers for payer-access engagements.
• Develop and execute Payer Strategy for regional/national payer accounts and Medicaid/Medicare bodies.
• Present analysis of data and economic outcomes to support product value proposition.
• Utilize Medical Science Liaisons for comprehensive product and disease state presentations.
• Deliver favorable access and reimbursement across payer accounts throughout product lifecycle.
• Partner with Academic Hospitals/Health Systems to ensure patient access as needed.
• Frequent interactions with Case Management to resolve access issues.
• Track KPIs and ensure dashboards reflect market access results.
• Adhere to Orca Bioscience’s core values and policies.
• Perform miscellaneous duties as assigned.

Skills

Payer reimbursement

Stakeholder relationships

Data analysis

Travel readiness

Education

Bachelor's Degree

Tools

Microsoft Excel

Microsoft Word

PowerPoint

Job description

More than one million people in the United States today are fighting blood cancer. While a traditional allogeneic stem cell transplant has been the best hope for many, the transplant itself can prove fatal or lead to serious conditions, such as graft vs. host disease. Orca Bio is a commercial-stage biotechnology company redefining the transplant process by developing next-generation cell therapies with the goal of providing significantly better survival rates with dramatically fewer risks. With our purified, high-precision cell therapies we hope to not only replace patients' blood and immune systems with healthy ones, but also restore their lives.

Position Summary: We are seeking a highly motivated individual to join our US Payer Field team (Market Access) as an Account Director, covering the Southeast US. Key states include FL, GA, TN, KY, WV, NC, SC, AL, OK, MS, AR, LA, and part of TX. Key desired payer relationships includeAetna, FL Blue, and regional payers in these states.

The primary objective of the Payer Account Director is to secure favorable coverage and reimbursement for all Orca Bio products through regional, national, and government payers. Account Directors are responsible for formulating and executing account plans engaging with both Regional and National Payer customers and working directly with targeted Academic Hospitals/Health Systems. In collaboration with field sales team members, this role will be integral to onboarding treatment centers and supporting broad, timely patient access. The Account Director will be a subject matter expert on all access related items including payer policy, pricing communication, and authorized treatment center reimbursement. Strong collaboration skills are a must as this role will require you to engage with several cross-functional teams including Field Sales, Medical Affairs, Legal, Quality, and Marketing, as required.

Key Responsibilities

• Serves as single-point-of-contact for all Authorized Treatment Centers (ATCs) with respect to field-related payer-access engagements (including onboarding) as identified by Orca Pod
• Develop and execute Payer Strategy for assigned regional and national payer accounts, state Medicaid agencies, and Medicare Administrative Contractors to secure access to Orca products, as well as on-going payer segmentation and business strategy tactics
• Present analysis of scientific data, clinical practice goals, guidelines, and anticipated economic program outcomes to support product value proposition
• Utilize clinical expertise of Medical Science Liaisons or medical providers in delivering comprehensive product and disease state presentations to key decision makers.
• Deliver and maintain favorable access, advantageous payer medical policy, and appropriate reimbursement for Orca products at regional & national payer accounts throughout the life cycle management of Orca’s portfolio.
• Accountable for partnerships with targeted Academic Hospitals/Health Systems to ensure patient access for Orca products on a case-by-case basis, as needed
• Frequent interactions with Orca’s Case Management team to resolve patient access issues
• Track KPIs and ensure accuracy of dashboards to measure account market access results
• Must adhere to Orca Bioscience’s core values, policies, procedures, and business ethics.
• Perform miscellaneous duties as assigned.

Required Qualifications

• Bachelor’s Degree
• 12+ years related Payer/Hospital reimbursement experience in the healthcare industry
• Proven relationships with Commercial Payer Medical Directors, Medicare Part A, State Medicaid, and Managed Medicaid stakeholders
• Strong analytical skills with experience in Payer Case rates, Payer policy development, and Payer Policy data tracking tools
• Problem solving skills and multi-tasking experience are critical
• Proactive, results-oriented, collaborative, self-starter with demonstrated strong leadership skills and experience in a complex reimbursement environment
• Excellent presentation skills, both written and verbal
• Knowledge of regulations and laws governing the protection of patient identifying information, OIG, FDA, and CMS policies pertaining to access
• Must be a true team player and work collaboratively with key internal stakeholders
• High level of proficiency in Microsoft Excel, Word and Power Point is required
• Open to frequent travel during site onboarding process and ad hoc meetings (~40%)

$250,000 - $285,000 a year

The anticipated annual salary range (listed above) for this job is based on prior experience in the role/industry, education, location, internal equity, and other job-related factors as permitted by law. For remote-based positions, this range may vary based on your local market. Full-time employment positions will also be eligible to receive pre-IPO equity and annual bonus, in addition to competitive medical, dental, and vision benefits, PTO, 401(k) plan, life and accidental death and disability coverage, and parental leave benefits. Other perks include subsidized daily lunches and snacks at our on-site locations.

Who we are

We are driven by a passion for science and compassion for patients. We act with urgency to ensure our treatments are one day accessible to all who need them.

We live by our core values of passion, courage, and integrity. Excellence in our work means the chance to unlock a better quality of life for our patients, and with that comes tremendous responsibility.

We innovate on a path that hasn’t been paved. We embrace an entrepreneurial spirit and take calculated risks to achieve our mission. We aren’t afraid to ask “why not” and challenge the status quo.

We maintain a start-up culture of camaraderie and leadership by example, regardless of title.

We’re proud to be an equal opportunity employer, and recognize that celebrating our differences creates stronger, lasting solutions that better serve our team, our patients and their healthcare providers.

Notice to staffing firms

Orca Bio does not accept resumes from staffing agencies with which we do not have a written agreement and specific engagement for a particular opening. Our employment activities, inquiries and offers are managed through our HR/Talent team, and all candidates are presented through this channel only. We do not accept unsolicited resumes, and we rarely outsource recruitment.