Director, Commercial Reimbursement

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🕒 May 15

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Calyxo, Inc.

WebsiteLinkedInAll Job Openings

11 - 50 employees

Founded 2016

⚕️ Healthcare Insurance

Healthcare Insurance

Calyxo, Inc. is a company focused on revolutionizing kidney stone care through innovative medical technology. Their flagship product, the CVAC System, is designed to efficiently clear kidney stones using a minimally invasive procedure called the SURE Procedure. This procedure integrates ureteroscopy, laser lithotripsy, microjet irrigation, dynamic aspiration, and stone collection to provide superior stone clearance rates compared to traditional methods. Backed by clinical evidence, Calyxo, Inc. aims to set a new standard in the management of kidney stone patients.

📋 Description

• 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

🎯 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

🏖️ Benefits

• 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