Director, Commercial Reimbursement - Remote, USA

 

Summary:

The Director of Commercial Reimbursement is responsible for leading Calyxo’s commercial health plan reimbursement strategy and execution. This role has accountability for commercial payer coverage strategy, payer negotiations, and reimbursement operations, including management of the Market Access Manager team. This position also provides leadership and coaching to the Market Access Manager team, ensuring clear priorities, strong execution, and ongoing development of capabilities across the function.

The position requires a balance of strategic payer engagement and oversight of reimbursement execution, with direct involvement in high‑impact or escalated coverage or payment challenges, policy appeals, claim denials, and provider support requiring senior‑level payer engagement or cross‑functional coordination. The Director will act as a subject‑matter expert on commercial coverage and payment and serve as a key partner to Commercial, Medical, and Sales leadership.

In This Role, You Will:

Commercial Payer Strategy and Policy Management

• Develop and execute commercial reimbursement strategies aligned with company objectives and growth plans.
• Lead engagement with national, regional, and local commercial health plans, including medical directors and policy teams.
• Drive efforts to influence, establish, or revise commercial payer medical policies, including:
  • Challenging non-coverage determinations, including “Investigational and Experimental” designations
  • Addressing restrictive utilization criteria
  • Supporting appropriate coverage pathways
• Lead escalation of payer policy disputes and coverage barriers that cannot be resolved through standard operational channels.
• Drive support for efforts to ensure appropriate reimbursement in cases of commercial payer underpayment
• Provide leadership on payer positioning, value messaging, and reimbursement implications of payer decisions.

Payer Negotiations and External Engagement

• Serve as the primary commercial reimbursement contact for payer negotiations and senior level escalations, including direct engagement with medical directors and payer leadership.
• Coordinate and support peer‑to‑peer, appeal, and reconsideration efforts involving clinical and provider stakeholders.
• Apply in‑depth understanding of commercial payer processes, timelines, and decision-making frameworks.

Physician and Provider Engagement

• Support the identification and development of physician champions to reinforce payer engagement activities.
• Partner with providers to address reimbursement issues across outpatient sites of service.
• Ensure reimbursement strategies align with real-world site‑of‑care dynamics and provider operational needs.

Reimbursement Operations and Team Leadership

• Provide direct people management and leadership for the Market Access Manager team.
• Establish and maintain standardized processes, tools, and best practices to ensure consistent field execution.
• Set performance expectations, coach team members, and support ongoing development.
• Serve as the escalation point for complex, high-risk, or precedent setting reimbursement issues with material access, revenue, or policy implications, including direct payer engagement when required.

Cross-Functional Collaboration

• Collaborate with Commercial, Sales, Medical Affairs, Legal, Compliance, and Finance teams to ensure integrated reimbursement planning and compliant execution.
• Provide reimbursement guidance to support commercial planning, launch readiness, and field enablement.
• Represent commercial reimbursement perspectives in cross functional forums and leadership discussions.

Reporting and Performance Management

• Develop metrics and reporting to assess reimbursement performance and identify areas of risk or opportunity.
• Use payer policy data and claims insights to inform strategic prioritization, escalation decisions, and payer engagement strategies, including identification of issues requiring senior level intervention.
• Drive continuous improvement in reimbursement strategy and operational effectiveness using data informed insights.

Who You Will Report To:

• Vice President, Market Access & Reimbursement

 Requirements:

• Bachelor’s degree required; advanced degree preferred (health policy, health services administration, public health).
• Minimum 8 years of progressively responsible experience, including accountability consistent with a Senior Manager or Director level role, in reimbursement, market access, or payer relations within medical devices or healthcare.
• Demonstrated experience working with commercial health plans, including policy review, coverage advocacy, and payer negotiations.
• Strong working knowledge of commercial health plan prior authorization, claims processing, and appeals in outpatient settings.
• Experience working with commercial payer data sources and claims datasets (e.g., payer policy intelligence platforms or DHC type claims data) to support coverage analysis, denial trends, and reimbursement decision making.
• Familiarity with coding, payment, and site‑of‑service considerations across multiple care settings.
• Experience partnering with physicians to support payer discussions or appeal strategies.
• Prior people management experience with accountability for team performance and development.
• Ability to effectively interact with multiple departments and functions; manage completion of multiple tasks.
• Ability to prioritize projects and display initiative and flexibility. Detail oriented & strong organizational skills.
• Excellent oral presentation skills via teleconference and in person.
• Strong technical, written and communication skills.
• Proficiency with productivity software including Microsoft Office (Word, Excel, Outlook, PowerPoint etc.)
• Willingness and ability to maintain up-to-date hospital credentialing requirements including all required vaccinations and immunizations.
• Travel: up to 40%
• Work location: Remote
• Full time employment
• Must be able to sit for up to 8 hours/day

What We Offer:

At Calyxo, you will be part of a knowledgeable, high-achieving, experienced and fun team.  You will work in a diverse work environment with experienced, proven leaders and have an opportunity to shape our company culture.  You will experience constant learning and dynamic challenges to help you grow and be the best version of yourself. 

We also offer an attractive compensation package, which includes:

• A competitive base salary range of $210,000 -  $225,000 and variable incentive plan
• Stock options – ownership and a stake in growing a mission-driven company
• Employee benefits package that includes 401(k), healthcare insurance and paid vacation