Principal US Market Access and Reimbursement Specialist

Primary Function of Position

This is a principal-level individual contributor role responsible for US market access and reimbursement strategy for Intuitives Future Forward growth platforms in the pre-launch period. The Principal US Market Access & Reimbursement Strategy works upstream and day to day with Clinical Affairs Regulatory Affairs HEOR Medical Affairs Business Development and R&D to define the optimal reimbursement pathway for each platform from first-in-human through launch readiness and to ensure that clinical study design and regulatory strategy are built with that pathway in mind weighing trade-offs across coding coverage and payment options and advising senior leaders on the risks sequencing and decisions needed to reach commercial viability. The role owns the coding coverage and payment intelligence that informs both the platforms currently in development and the technologies under evaluation for incubation licensing or partnership.

The role is focused on strategy judgment and senior-level advisory impact delivered hands-on rather than through a team. It requires deep working knowledge of the US reimbursement environment: CPT HCPCS and ICD-10 coding at a certified coders level; Medicare coverage and payment methodologies (OPPS MPFS IPPS); innovative payment pathways including NTAP TPT and NT-APC; provider economics across sites of service including hospital margin physician economics and quality-linked payment programs; and early commercial payer strategy. The successful candidate will have health economics and evidence generation experience will work independently in the codes and the data and will present directly to senior management and executives. HEOR builds the economic models and evidence; this role defines what evidence the reimbursement pathway requires directs that work and translates it for payers and leadership. The role sits alongside Clinical Affairs and Regulatory Affairs as a standing member of each platform team contributing to IDE and pivotal study design endpoint and comparator selection indication and labeling decisions and FDA pathway choices wherever they carry coding coverage or payment consequences. The US is the primary market; prior international reimbursement or HTA experience is strongly preferred so that US pathway decisions can be read across to global evidence planning.

Essential Job Duties

Reimbursement Strategy Coding Coverage & Payment Analysis

• Define and own the US reimbursement strategy for each Future Forward growth platform including pathway selection sequencing timelines and critical dependencies; advise senior leaders on the trade-offs and decision points for programs with ambiguous or novel payment pathways.
• Independently conduct detailed analyses of CPT HCPCS Level II and ICD-10-CM/PCS code applicability for growth platform procedures including crosswalk and analog selection bundling and modifier logic and NCCI edits and defend the rationale to internal and external stakeholders.
• Track and interpret CMS rule-making cycles (OPPS MPFS IPPS proposed and final rules) and translate implications for platform reimbursement.
• Analyze APC assignment RVU values payment rates and packaging logic to identify reimbursement risks and opportunities across hospital outpatient ASC and physician office settings.
• Assess MAC LCDs NCDs and commercial payer policies for existing coverage signals and likely coverage barriers relevant to growth platforms ahead of launch.

Medicare Innovative Payment Pathways

• Lead the development of NTAP TPT and NT-APC applications for eligible growth platform technologies.
• Monitor CMS pathway eligibility criteria application windows and approval precedents to identify strategic opportunities.
• Build and maintain reimbursement scenario analyses comparing standard payment versus innovative pathway scenarios.
• Track competitor and adjacent-technology applications and outcomes to inform Intuitives pathway strategy.
• Partner with HEOR colleagues on the evidence requirements that support innovative payment pathway submissions.

Early Payer Strategy & Engagement

• Build pre-launch commercial payer landscape assessments across national and regional plans and Medicaid MCOs to establish the likely coverage position at launch.
• Design and execute early payer engagement activities pre-launch advisory boards payer interviews mock P&T discussions and payer perception research and synthesize findings into actionable input for evidence plans and value story refinement.

Provider Economics Health Economics & Claims Data

• Contribute to provider economics analyses across hospital inpatient outpatient ASC and physician settings hospital margin and contribution analyses physician payment and RVU economics cost-to-charge and cost report considerations and the effect of quality-linked payment programs (e.g. HAC Reduction HRRP hospital VBP) on the case for adoption.
• Define the evidence needed to support coding coverage and payment decisions and partner with HEOR Clinical and epidemiology colleagues to design and scope the studies registries and real-world data analyses that generate it.
• Direct and critically review HEOR budget impact cost-consequence and cost-effectiveness work from a reimbursement perspective and translate the outputs into provider- and payer-facing economic narratives.
• Use claims and hospital databases (e.g. Definitive Healthcare or comparable platforms) where needed to inform procedural volume site-of-care trends and payer mix.

Clinical & Regulatory Integration

• Partner with Clinical Affairs on the design of feasibility IDE and pivotal studies so that endpoints comparators populations sites of service and resource-use data capture support future coding coverage and payment applications as well as regulatory authorization.
• Partner with Regulatory Affairs on indication wording labeling device classification and FDA pathway selection (510(k) De Novo PMA Breakthrough Device designation) identifying where regulatory choices determine NTAP TPT NT-APC or CPT eligibility and timing.
• Align regulatory clinical and reimbursement milestones into a single integrated timeline for each platform and flag sequencing conflicts (e.g. FDA authorization timing versus CMS application windows) to platform and senior leadership.
• Contribute reimbursement input to clinical evidence plans registries and post-market study design and to the clinical sections of coding and payment applications (clinical vignettes physician work descriptions resource-use narratives).
• Serve as the reimbursement member of cross-functional platform teams working day to day with Clinical Regulatory R&D and HEOR colleagues rather than as a downstream reviewer.

Pipeline Diligence & Business Development Support

• Lead reimbursement diligence on candidate technologies under evaluation for internal incubation licensing partnership or acquisition producing structured viability assessments covering coding pathway payment adequacy coverage outlook and innovative payment pathway eligibility.
• Serve as a thought partner to Future Forward leadership and Business Development colleagues during early-stage opportunity assessment surfacing reimbursement risks and opportunities that should inform go/no-go decisions.
• Contribute reimbursement perspective to platform-shaping decisions indication selection site-of-care strategy procedural design and evidence requirements ensuring payment economics are factored in early rather than retrofitted.
• Maintain ongoing competitive and adjacent-technology intelligence tracking competitor NTAP/TPT/NT-APC applications recent CMS coverage decisions CPT Category III activity and emerging signals on future payment policy.
• Prepare and present reimbursement-focused materials and analyses for portfolio reviews stage-gate meetings and investment committee discussions.

KOL External Engagement & Communication

• Engage directly with clinical coding and reimbursement KOLs hospital revenue cycle leaders and reimbursement consultants to gather real-world coding behavior claims intelligence and payer experience.
• Lead advisory boards payer interviews and coding roundtables including planning content development and synthesis of outputs.
• Attend AMA CPT Editorial Panel and RUC meetings and relevant reimbursement-focused conferences (e.g. AdvaMed AAPC AHIMA) as required and contribute to internal debriefs.
• Produce clear well-designed slide decks and written reports for senior Medical Affairs HEOR Commercial and executive audiences; translate complex reimbursement concepts into accessible narratives for non-specialist audiences.
• Operating in a global matrix partner with senior Medical Affairs HEOR Clinical Business Development Regulatory and R&D colleagues to ensure reimbursement implications are integrated into platform development and pipeline decisions and maintain compliance with applicable transparency anti-kickback and Medical Affairs interaction frameworks.

Qualifications :

Required Experience and Education

• Minimum 15 years of related experience in US market access reimbursement coding or health policy roles within medical device biotech consultancy payer or hospital settings with a bachelors degree; or 12 years with a masters degree; or a PhD with 8 years of experience; or an equivalent combination of education and experience.
• Bachelors degree required; advanced degree (MS MBA MPH PhD or equivalent) preferred.
• AAPC Certified Professional Coder (CPC) or equivalent (COC CRC AHIMA CCS) strongly preferred and highly valued; candidates without certification should demonstrate equivalent working fluency in procedural coding and a willingness to obtain CPC within 12 months of hire.
• Track record of developing and executing US reimbursement strategy for novel or first-of-kind procedural technologies from early pipeline through launch and of personally producing the underlying reimbursement analyses coding assessments and payer policy reviews rather than directing a team.
• Demonstrated experience with CMS innovative payment pathways (NTAP TPT NT-APC) including at least one application taken through to decision.
• Experience working directly with Clinical Affairs and Regulatory Affairs on device programs including contributing reimbursement input to study design endpoint selection indication wording or FDA pathway decisions.
• Health economics and evidence generation experience: contributing to budget impact or cost-effectiveness models shaping clinical or real-world evidence plans to meet payer and CMS requirements and working with published economic and clinical literature.
• Demonstrated track record of executing early payer engagement activities (advisory boards payer interviews payer perception research) and KOL engagement in a pre-launch setting.
• Experience in a pre-launch or early-pipeline environment where reimbursement strategy had to be built ahead of clinical evidence ideally taking a procedural technology from feasibility through launch readiness.
• International reimbursement market access or HTA experience (e.g. NICE G-BA HAS MHLW/Chuikyo MSAC) strongly preferred; working familiarity with claims and hospital databases (e.g. Definitive Healthcare) preferred.

Required Knowledge Skills and Abilities

• Deep fluency in CPT HCPCS Level II and ICD-10-CM/PCS coding with the ability to work in the codes independently at a certified coders level crosswalk and analog selection bundling and modifier logic NCCI edits and the reasoning behind how a procedure will actually be coded and billed in practice.
• Strong working knowledge of Medicare payment methodologies (OPPS/APC MPFS/RVU IPPS/MS-DRG) and rule-making cycles; practical familiarity with commercial payer policy structures MAC LCDs and coverage determination processes.
• Strong understanding of provider economics including hospital margin and physician economics by site of service and how quality-linked payment programs and penalties shape hospital purchasing and adoption decisions.
• Working knowledge of FDA device pathways (510(k) De Novo PMA Breakthrough Device) and clinical study design fundamentals sufficient to engage credibly with Regulatory and Clinical colleagues and to identify where their decisions affect reimbursement.
• Working knowledge of AMCP Format and analogous device/procedural payer dossier conventions and of how pre-launch evidence plans map to commercial medical policy and prior authorization requirements.
• Proven ability to translate HEOR outputs (cost-effectiveness budget impact real-world evidence) into payer-digestible narratives and to communicate economic content credibly to medical and pharmacy directors.
• Strong written and verbal communication with proven ability to distill complex reimbursement detail tailor it to varying audiences and deliver impactful presentations to senior management and executives.
• Independent working style: determines methods and priorities on new assignments drives results with limited supervision and can be relied upon to assess known and unknown factors and determine the best way forward for the business while partnering closely across a global matrix.
• Advanced PowerPoint and Excel; comfort with data manipulation and visualization.
• US-based; willingness to travel up to 25% domestically for KOL engagements advisory boards and conferences with occasional international travel.

Additional Information :

Due to the nature of our business and the role please note that Intuitive and/or your customer(s) may require that you show current proof of vaccination against certain diseases including COVID-19.  Details can vary by role.

Intuitive is an Equal Opportunity Employer. We provide equal employment opportunities to all qualified applicants and employees and prohibit discrimination and harassment of any type without regard to race sex pregnancy sexual orientation gender identity national origin color age religion protected veteran or disability status genetic information or any other status protected under federal state or local applicable laws.

Mandatory Notices

U.S. Export Controls Disclaimer:  In accordance with the U.S. Export Administration Regulations (15 CFR 743.13(b)) some roles at Intuitive Surgical may be subject to U.S. export controls for prospective employeeswho are nationals from countries currently on embargo or sanctions status.

Certain information you provide as part of the application will be used for purposes of determining whether Intuitive Surgical will need to (i) obtain an export license from the U.S. Government on your behalf (note: the governments licensing process can take 3 to 6 months) or (ii) implement a Technology Control Plan (TCP) (note: typically adds 2 weeks to the hiring process).  

For any Intuitive role subject to export controls final offers are contingent upon obtaining an approved export license and/or an executed TCP prior to the prospective employeesstart date which may or may not be flexible and within a timeframe that does not unreasonably impede the hiring need. If applicable candidates will be notified and instructed on any requirements for these purposes. 

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Preference will be given to qualified candidates who do not reside or plan to reside in Alabama Arkansas Delaware Florida Indiana Iowa Louisiana Maryland Mississippi Missouri Oklahoma Pennsylvania South Carolina or Tennessee.

This position may be filled at a different job level than listed here depending on
business need and/or on the selected candidates experience knowledge and skills.
Compensation will be based primarily on the job level at which the role is filled and the
candidates qualifications consistent with applicable law.

Accommodation & Accessibility Notice:

Intuitive is committed to providing reasonable accommodations to qualified individuals with disabilities. If you require assistance or an accommodation during any part of the application or interview process please contact People Services at

We provide market-competitive compensation packages inclusive of base pay incentives benefits and equity. It would not be typical for someone to be hired at the top end of range for the role as actual pay will be determined based on several factors including experience skills and qualifications. The target compensation ranges are listed.

Remote Work :

No

Employment Type :

Full-time