Director of Payor Relations
Director of Payor Relations
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Job Description
Director Payor Relations Market Access & Reimbursement
Location: Insert location or remote status
Travel: Up to 20% domestic
Position Summary
We are seeking a strategic and experienced Director of Payor Relations to lead efforts in coverage coding and reimbursement strategy for a portfolio of innovative medical technologies. This individual will drive engagement with commercial and government payors advocate for favorable coverage decisions and ensure broad patient access through compelling clinical and economic evidence.
This role is highly cross-functional requiring close collaboration with Market Access Health Economics & Outcomes Research (HEOR) Medical Affairs Clinical and Commercial teams to ensure product value is demonstrated and payer-aligned strategies are embedded throughout the product lifecycle.
Key Responsibilities
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Develop and execute payor engagement strategies to drive coverage coding and reimbursement across public and private payors.
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Cultivate trusted relationships with Medical Directors Policy Teams and Chief Medical Officers at health plans and payer organizations.
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Lead payer-facing presentations that convey clinical value health economic evidence and patient outcomes to support access.
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Collaborate with internal HEOR Clinical and Medical Affairs teams to develop payer-facing materials (e.g. dossiers value propositions economic models).
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Support CPT and HCPCS coding efforts including submissions and cross-functional strategy in partnership with coding experts and societies.
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Monitor changes in policy and reimbursement trends and proactively identify opportunities and risks for market access.
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Partner with sales and field reimbursement teams to resolve local access barriers and support pull-through initiatives.
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Contribute to pricing strategy and commercialization planning by forecasting reimbursement trends and payor adoption.
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Serve as the internal voice of the payer ensuring access considerations shape commercial strategy and product positioning.
Qualifications
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Bachelor s degree required; advanced degree in health economics public health or related field preferred.
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8 years in market access payor relations or reimbursement within the medical device diagnostics or biopharma industries.
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Experience influencing payor policy development especially within Medicare Medicaid and large commercial health plans.
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Strong knowledge of CPT III/HCPCS coding payment systems and coverage pathways.
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Demonstrated success in securing or improving coverage and reimbursement for novel technologies or procedures.
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Skilled in translating complex clinical and economic data into clear actionable messaging for payor stakeholders.
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Experience in ophthalmology surgical specialties or similar high-specialty areas is preferred but not required.
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Strong presentation negotiation and interpersonal skills.
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Ability to work cross-functionally and independently in a fast-paced evolving environment.
Additional Preferred Qualifications
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Experience navigating site-of-service reimbursement differences (ASC HOPD physician office).
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Pre-existing relationships with payor medical directors societies or reimbursement consultants.
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Familiarity with US healthcare policy trends and evolving value-based care models.
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Leadership experience or team-building skills are a plus.
Work Environment & Travel
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Hybrid or remote flexibility depending on candidate location.
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Approximately 20% travel expected for payor meetings conferences or internal team collaboration
Employment Type
Full-time
