Healthcare Market Access Counsel

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🔥 1 minute ago

🇺🇸 United States – Remote

💵 $152k - $196k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚖️ Legal Counsel / General Counsel

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📋 Description

• Lead legal strategy and provide senior-level counsel on payer contracting, reimbursement, coverage, and broader market access matters • Independently lead the review, drafting, and negotiation of complex agreements with private payors, commercial insurers, and managed care organizations • Advise Market Access and senior business leaders on payer strategy, reimbursement frameworks, coverage initiatives, and market access opportunities and risks • Translate complex legal and regulatory requirements into practical business recommendations • Lead legal support for reimbursement and appeals strategies • Advise on compliance with federal and state healthcare laws, regulations, and guidance affecting billing, coding, reimbursement, payer contracting, and coverage • Evaluate payer policies, coverage determinations, reimbursement requirements, and contractual provisions, identifying legal, regulatory, and business risks • Influence cross-functional decision-making with pragmatic legal guidance • Develop legal frameworks, playbooks, contracting positions, templates, and scalable processes • Establish and deliver guidance and training on payer contracting, reimbursement requirements, healthcare regulatory developments, and market access considerations • Monitor changes in the healthcare legal and regulatory landscape, including PAMA, defrayal obligations, and state biomarker coverage legislation • Partner with Legal and Compliance leadership on complex or high-risk matters and escalate issues appropriately • Provide leadership and subject-matter expertise in healthcare, reimbursement, payer contracting, and market access • Work collaboratively in accordance with company values

🎯 Requirements

• Juris Doctor (JD) from an accredited law school and active bar membership in good standing • 5+ years of relevant legal experience, including healthcare law, market access, or payer contracting • Experience reviewing and negotiating contracts with private payors, health plans, or managed care organizations • Strong understanding of U.S. healthcare reimbursement and coding systems, including commercial insurance and managed care structures, the MolDx program, AMA CPT codes, and the CLFS • Demonstrated experience supporting or advising on appeals strategies, coverage disputes, or reimbursement challenges • Ability to translate complex legal and regulatory issues into clear, actionable guidance for business partners • Strong collaboration and communication skills, with a track record of working effectively across cross-functional teams • High level of integrity, sound judgment, and attention to detail • Experience in diagnostics, life sciences, or laboratory services environments preferred • Familiarity with payer policy development, utilization management, or claims adjudication processes preferred • Experience working closely with market access, billing, revenue cycle, or reimbursement teams preferred • Knowledge of federal and state healthcare regulations impacting diagnostics and coverage preferred • Prior in-house experience in a growth-oriented healthcare or biotech organization or a commercial insurance company preferred • Comfort navigating ambiguity and contributing to evolving processes in a dynamic, mission-driven environment preferred

🏖️ Benefits

• Competitive compensation and benefits • Potential eligibility for discretionary bonuses/incentives • Potential eligibility for restricted stock units • Inclusive workforce and workplace culture • Career opportunities and professional growth in a purpose-driven environment • Great Place to Work-certified workplace

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