Director of Payor Relations

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

• Develop and execute payor engagement strategies to drive coverage, coding, and reimbursement across public and private payors.

• Cultivate trusted relationships with Medical Directors, Policy Teams, and Chief Medical Officers at health plans and payer organizations.

• Lead payer-facing presentations that convey clinical value, health economic evidence, and patient outcomes to support access.

• Collaborate with internal HEOR, Clinical, and Medical Affairs teams to develop payer-facing materials (e.g., dossiers, value propositions, economic models).

• Support CPT and HCPCS coding efforts , including submissions and cross-functional strategy in partnership with coding experts and societies.

• Monitor changes in policy and reimbursement trends and proactively identify opportunities and risks for market access.

• Partner with sales and field reimbursement teams to resolve local access barriers and support pull-through initiatives.

• Contribute to pricing strategy and commercialization planning by forecasting reimbursement trends and payor adoption.

• Serve as the internal "voice of the payer" , ensuring access considerations shape commercial strategy and product positioning.

Qualifications

• Bachelor’s degree required; advanced degree in health economics, public health, or related field preferred.

• 8+ years in market access, payor relations, or reimbursement within the medical device, diagnostics, or biopharma industries.

• Experience influencing payor policy development , especially within Medicare, Medicaid, and large commercial health plans .

• Strong knowledge of CPT III/HCPCS coding, payment systems , and coverage pathways .

• Demonstrated success in securing or improving coverage and reimbursement for novel technologies or procedures.

• Skilled in translating complex clinical and economic data into clear, actionable messaging for payor stakeholders.

• Experience in ophthalmology, surgical specialties , or similar high-specialty areas is preferred but not required.

• Strong presentation, negotiation, and interpersonal skills.

• Ability to work cross-functionally and independently in a fast-paced, evolving environment.

Additional Preferred Qualifications

• Experience navigating site-of-service reimbursement differences (ASC, HOPD, physician office).

• Pre-existing relationships with payor medical directors, societies, or reimbursement consultants .

• Familiarity with US healthcare policy trends and evolving value-based care models.

• Leadership experience or team-building skills are a plus.

Work Environment & Travel

• Hybrid or remote flexibility depending on candidate location.

• Approximately 20% travel expected for payor meetings, conferences, or internal team collaboration