Director, Payer Relations

Overview

• Drive strategic payer relations to secure coverage, coding, and reimbursement for innovative healthcare technologies addressing chronic conditions.
• Lead cross-functional collaboration with Sales, Market Access, Medical Affairs, and Marketing teams to align payer strategies with organizational goals.
• Engage with commercial and government payers to establish sustainable access pathways for current and future technologies.
• Develop and execute comprehensive reimbursement strategies across commercial plans, Medicare, and Medicaid.
• Provide consultative support to healthcare providers, addressing reimbursement challenges and minimizing access barriers.
• Build relationships with advocacy groups, professional societies, and healthcare systems to support long-term growth.
• Travel nationwide approximately 50% to engage with stakeholders and oversee strategic initiatives.

Key Responsibilities & Duties

• Lead and manage the Payer Relations Directors team to ensure effective coordination of reimbursement support for healthcare providers.
• Drive payer engagement to secure coverage for newly marketed products and resolve reimbursement challenges.
• Support healthcare providers by addressing reimbursement needs in partnership with Sales and Market Access leadership.
• Establish and maintain strategic payer and stakeholder relationships to support long-term growth and minimize access barriers.
• Provide regular updates to senior leadership on payer and reimbursement strategies and outcomes.
• Execute outreach with state and local provider, patient, and healthcare advocacy organizations to advance access initiatives.
• Collaborate cross-functionally with internal teams to align payer and provider strategies with organizational goals.
• Travel approximately 50% nationwide to engage with stakeholders and oversee strategic initiatives.

Job Requirements

• Bachelor’s degree in a relevant field is required.
• 12+ years of industry experience, including 10+ years in medical device, biotechnology, or pharmaceutical sectors.
• Minimum of 4 years of people management experience, with at least 2 years in payer leadership roles.
• Deep expertise in Medicare Fee-for-Service (FFS) and existing relationships with Medicare Administrative Contractors (MACs).
• Strong understanding of Commercial, Medicare, and Medicaid reimbursement strategies.
• Proven leadership, relationship management, and cross-functional collaboration skills.
• Experience with patient management programs and familiarity with patient CRM systems is preferred.
• Excellent communication skills with the ability to articulate clinical value and reimbursement strategies effectively.