Principal Regulatory & Market Strategy

Principal Regulatory & Market Strategy

Requirements

• Bachelor’s degree in business administration or relevant areas as outlined by essential duties; or High School Diploma and 4+ years of relevant experience in lieu of degree.
• 8+ years of experience advising health care organization(s) on legal, regulatory and strategy topics related to government and commercial insurance coverage, billing and reimbursement, fraud/waste/abuse, provider licensing, and patient/consumer protection.
• Advanced knowledge and understanding of official health care billing and coding guidelines, including those from the Centers for Medicare and Medicaid Services (CMS) and other agencies within the Department of Health & Humans Services (HHS).
• Strong written, verbal, and presentational communication skills; ability to present to senior level leadership and external professional audiences.
• Demonstrated ability to perform the Essential Duties of the position with or without accommodation.
• Authorization to work in the United States without sponsorship.

Responsibilities

• Promptly and proactively assessing and researching U.S. health care legal, regulatory and strategy topics to provide high quality guidance and direction to laboratory and operational leaders.
• Collaborating (and representing the Market Access & Strategy Team) with other teams and departments to mitigate or resolve issues and barriers related to the performance and billing of laboratory testing and related patient services.
• Engaging with regulatory agencies, outside counsel, consultants, and industry groups to better understand market dynamics and/or advocate on behalf of Exact Sciences to advance our overall reimbursement and business strategy.
• Maintaining current knowledge of official health care billing and coding guidelines and national trends, including those from the Centers for Medicare and Medicaid Services (CMS) and other agencies within the Department of Health & Humans Services (HHS).
• Maintaining awareness of federal and state regulation of medical devices and laboratories.
• Identifying potential weaknesses in Exact Sciences’ business strategy and proactively suggesting improvements to address them.
• Preparing presentations or deliverables for company management.
• Ability to take direction and independently work to complete projects.
• Uphold company mission and values through accountability, innovation, integrity, quality, and teamwork.
• Maintain regular and reliable attendance.
• Ability to act with an inclusion mindset and model these behaviors for the organization.
• Ability to work a designated schedule.
• Ability to work on a mobile device, tablet, or in front of a computer screen and/or perform typing for approximately 90% of a typical working day.
• Ability and means to travel between Exact Sciences locations in Madison, WI, if onsite, and to Exact Sciences locations in Madison, WI, if remote.
• Ability to travel 10% of working time away from work location; may include overnight/weekend travel.

Preferred Qualifications

• J.D. degree
• Advanced understanding of health care provider revenue cycle functions, processes, and health care IT systems.
• Experience with unique provider-payer contracting arrangements, including value-based care.
• 3+ years of experience advising genomic or genetic CLIA laboratory providers on legal and/or strategy matters.