The Director of Payer Relations and Policy is responsible for leading the public and private payer policy efforts of the Immune Deficiency Foundation, ensuring that policies developed by private insurance companies and public payers provide full access to necessary care and treatments for individuals with primary immunodeficiencies (PI). Support of additional IDF initiatives may be required. This position will represent the organization to the public and interact closely with other staff members, particularly those involved in patient services, research, and communications.
Principal Duties And Responsibilities
- Provide advice to staff handling “Ask IDF” payer inquiries and provide direct answers to complex payer questions and challenges.
- Identify issues gleaned from IDF inquiries to inform payer policy priorities.
- Lead public policy team efforts to set payer policy priorities.
- Develop and implement strategies to address systemic public and private payer challenges.
- Coordinate with consulting physicians to address specific policy challenges by writing letters, pulling together materials, sending emails and coordinating phone consultations with payer representatives.
- Communicate with patient advocates from therapy producers to identify coverage challenges and coordinate advocacy to support access for individuals with PI.
- Communicate with other patient advocacy organizations to stay informed about broad health access challenges and successful strategies being implemented.
- Plan and implement payer education efforts including recruiting payer participants, developing agenda, materials and presenting programs.
- Develop relationships with major payer representatives.
- Add content to the payer webpage an ensure it is regularly updated.
- Utilize the Canary Insights tool to identify payers and help address challenges.
- Draft payer-related content for e-newsletters, blogs and other communication needs.
- Advise and assist public policy team on payer issues impacting federal and state advocacy.
- Stay informed on public policy developments relate to Medicare, Medicaid and the Affordable Care Act and understand the implications to payer policies.
- All other duties as assigned.
- Bachelor’s degree or equivalent experience.
- Any equivalent combination of training, education, and experience that demonstrates the ability to perform the essential functions of the position.
- Minimum of five years’ experience working for or interacting with health insurance and/or healthcare payer entities
- A considerable amount of work-related skill, knowledge, or experience is needed to perform the essential functions of this role.
- Experience working on issues related to Medicare, Medicaid, TriCare and/or other public healthcare payer programs
- Experience analyzing private health insurance policies and related documents
Proficiency in the following software programs is necessary for this role:
- Microsoft Office, including Word, Excel, PowerPoint, Outlook
- Internet Browsers (Firefox, Chrome)
- CRM software
- Project management software
- Canary Insights