Director, Commercial Reimbursement
New
Fully remote work flexibility within the United StatesFull-TimeDirector
Salary210,000 - 225,000 USD per year
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Job Details
- Experience
- Minimum of 8 years
- Required Skills
- Project ManagementPeople ManagementData analytics
Requirements
- Bachelor’s degree required; advanced degree in health policy, public health, health services administration, or related field preferred.
- Minimum of 8 years of progressive experience in reimbursement, market access, payer relations, or healthcare strategy within medical devices or healthcare organizations.
- Proven expertise working with commercial health plans, payer negotiations, policy reviews, and coverage advocacy initiatives.
- Strong understanding of prior authorization processes, claims management, appeals, reimbursement operations, and outpatient reimbursement pathways.
- Experience working with commercial payer intelligence platforms, claims datasets, and reimbursement analytics tools.
- Familiarity with coding, reimbursement methodologies, and site-of-service considerations across healthcare settings.
- Demonstrated experience partnering with physicians and providers on payer discussions, appeals, and reimbursement strategies.
- Prior people management experience with accountability for team performance, coaching, and employee development.
- Strong organizational and project management skills with the ability to manage multiple priorities and cross-functional initiatives.
- Excellent communication, presentation, and stakeholder management skills in both virtual and in-person settings.
Responsibilities
- Lead the development and execution of commercial reimbursement strategies aligned with organizational growth objectives and market access priorities.
- Manage relationships with national, regional, and local commercial health plans, including direct engagement with medical directors and payer leadership teams.
- Drive commercial payer coverage initiatives by influencing reimbursement policies, challenging restrictive coverage determinations, and supporting appropriate access pathways.
- Lead escalation efforts for complex payer disputes, reimbursement barriers, policy appeals, underpayment issues, and high-risk coverage challenges.
- Serve as the primary reimbursement expert for payer negotiations, peer-to-peer discussions, reconsideration requests, and provider support initiatives.
- Partner with physicians and healthcare providers to support reimbursement advocacy efforts, operational alignment, and site-of-care reimbursement strategies.
- Oversee reimbursement operations and provide leadership, coaching, and development support to the Market Access Manager team.
- Establish standardized processes, tools, and best practices to ensure operational consistency and high-quality reimbursement execution across the organization.
- Collaborate cross-functionally with commercial, sales, finance, legal, medical affairs, and compliance teams to support launch readiness, field enablement, and reimbursement planning.
- Develop reimbursement performance metrics, reporting dashboards, and analytical insights to identify risks, opportunities, and strategic priorities.
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