Payer Contracting Lead (Cell Gene & Advanced Therapy)

The Medical & CGT Payer Contracting Lead plays a critical role in ensuring broad medical payer reimbursement access for Biologics' medical benefit and cell & gene therapy (CGT) medications. This position focuses on negotiating, executing, and managing reimbursement agreements with national and regional payers.

You will collaborate closely with internal teams and the CGT Lead Payer Specialist to oversee payer relationships, contracts, performance guarantees, reporting, and payment processes. This role is essential in enabling timely patient access to innovative therapies while reducing financial and administrative barriers.

Key Responsibilities

• Payer Contracting: Lead the end-to-end payer contracting process, including financial modeling, credentialing/recredentialing, and payment yield management. Partner with Legal, Finance, Operations, and other stakeholders.
• Relationship Management: Maintain and strengthen payer relationships to ensure network access and coverage for CGT and medical benefit therapies.
• Payment Model Expertise: Provide guidance on reimbursement models (e.g., ASP, AAC, NADAC, CMMI) to internal teams.
• CGT Collaboration: Work with cross-functional teams and payers to ensure compliance with requirements such as precertification, prior authorization, billing, and payment.
• Stakeholder Liaison: Act as a key contact for biopharmaceutical manufacturers and payers regarding drug policies, CGT landscape, and reimbursement strategies.

Minimum Requirements

• Bachelor's degree or equivalent experience.
• 10+ years of relevant experience.

Critical Skills

• Minimum 7 years in specialty pharmacy, medical ancillary contracting, or related services.
• At least 5 years in medical and/or pharmacy payer reimbursement contracting.
• Strong understanding of payer medical policies, prior authorizations, HCPCS codes, and therapy approval processes.
• Experience in specialty healthcare or pharmaceutical segments; CGT knowledge is a plus.
• Familiarity with healthcare laws and regulations (HIPAA, Medicare, Medicaid).
• Proficiency in Microsoft Office Suite.

Additional Skills

• Excellent verbal and written communication skills.
• Ability to collaborate across business units and influence stakeholders.
• Strong prioritization, time management, and project management skills.
• Analytical and problem-solving abilities, including issue resolution related to treatment logistics.
• Experience with pharmaceutical manufacturers is a plus.

Physical Requirements

• Office environment.
• Less than 30% travel.