Director, Commercial Reimbursement

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Calyxo, Inc.

SiteLinkedInTodas as Vagas

11 - 50 funcionários

Fundada em 2016

⚕️ Seguro de Saúde

Healthcare Insurance

A Calyxo, Inc. é uma empresa focada em revolucionar o tratamento de cálculos renais por meio de tecnologia médica inovadora. Seu produto principal, o Sistema CVAC, é projetado para remover cálculos renais de forma eficiente usando um procedimento minimamente invasivo chamado Procedimento SURE. Este procedimento integra ureteroscopia, litotripsia a laser, irrigação com microjatos, aspiração dinâmica e coleta de pedras para proporcionar taxas de remoção de pedras superiores em comparação com os métodos tradicionais. Com respaldo de evidências clínicas, a Calyxo, Inc. pretende estabelecer um novo padrão no manejo de pacientes com cálculos renais.

Descrição

• 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 • 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 • 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 • 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 • 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 • 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

🎯 Requisitos

• 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

🏖️ Benefícios

• 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