The Payer Relations Director (PRD) leads payer strategy within an assigned region to secure and maintain favorable coverage, coding, and reimbursement across commercial plans, Medicare (MACs), and Medicaid. This role drives access for current and newly launched products by establishing payer relationships, resolving reimbursement barriers, and ensuring fair and consistent payment. The PRD partners cross-functionally with Sales, Reimbursement Liaisons, Medical Affairs, and Customer Relations to support KOL physicians and institutional customers, influence payer policy, and enable provider adoption and patient access. Serving as a subject-matter expert in payer policy and buy-and-bill reimbursement, the PRD engages with medical directors, MACs, state agencies, and advocacy groups to build sustainable coverage pathways and support future technologies. Extensive field engagement and travel required.
What Will You Do?
- Develop and execute regional and national payer strategies to secure and maintain coverage, coding, and reimbursement across Commercial, Medicare (MACs), and Medicaid.
- Partner with Sales and Reimbursement Liaison teams to support KOL providers, remove access barriers, and resolve complex reimbursement challenges.
- Build and sustain relationships with payers, MAC medical directors, state agencies, and advocacy organizations to influence policy and coverage decisions.
- Serve as the payer and reimbursement subject-matter expert, guiding internal teams and customers on buy-and-bill, coding, billing, and appeals processes.
- Drive access strategy for current and future technologies through cross-functional collaboration with Sales, Medical Affairs, and Customer Relations.
- Understand and work with key health care stakeholders within the following customers: * Commercial Managed Care (Regional Plans) * Medicare (Part A, B, C, D; Carriers) * Medicaid (Fee for Service, Managed Care Organizations) * State Government Health Staffers * Veteran's Administration (VISNs) * TRICARE Regional Offices * Specialty Pharmacy & Pharmacy Benefit Managers * Medical Groups * State Advocacy, patient, provider and other key healthcare stakeholder groups.
How Will You Get Here?
- Bachelor's degree required; advanced degree or practice management experience preferred.
- 10 plus years of industry experience in payer/reimbursement roles within medical devices and biologics (buy-and-bill, injectable products strongly preferred).
- Minimum 2 years experience: practice management, practice billing and revenue cycle, public or private third party reimbursement related to product access impact on providers, or pharmaceutical/managed care industry reimbursement.
- Proven experience with payer strategy, reimbursement, and account management; direct product launch experience highly desirable.
- Deep knowledge of Commercial, Medicare, and Medicaid reimbursement structures, coding (e.g., J/T codes), billing, and appeals processes.
- Strong executive presence and stakeholder engagement skills with payers, KOLs, health systems, and government entities.
- Highly organized, self-directed, and effective in cross-functional environments.
- Willingness to travel extensively (50% / 3-4 nights/week).
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