Director, Market Access – Commercial Coverage & Reimbursement
The Director, Market Access – Commercial Coverage & Reimbursement will lead the company's U.S. commercial payer strategy to expand patient access to genomic sequencing and genetic testing. This individual will develop and execute strategies to achieve favorable coverage, reimbursement, and utilization policies across national and regional commercial health plans. The role requires deep expertise in commercial payer decision-making, evidence generation, reimbursement policy, and provider adoption. Working cross-functionally with Medical Affairs, Health Economics & Outcomes Research (HEOR), Clinical Affairs, Government Affairs, Commercial, and Legal, this leader will translate clinical and economic evidence into successful market access strategies that improve patient access to genomic sequencing and genetic testing while supporting business growth.
Responsibilities
- Develop and execute commercial payer strategies for new and existing genomic sequencing and genetic testing products.
- Lead engagement with national and regional commercial insurers to secure favorable coverage policies.
- Build relationships with medical directors, laboratory benefit managers (LBMs), reimbursement leaders, and payer policy teams.
- Partner with HEOR and Medical Affairs to develop clinical and economic evidence supporting payer adoption.
- Monitor commercial payer policies, reimbursement trends, and utilization management practices.
- Support product launches by developing payer value propositions and access strategies.
- Collaborate with Government Affairs to align commercial and public payer strategies.
- Serve as the company's commercial payer subject matter expert.
Requirements
- Bachelor's degree required; advanced degree preferred (MBA, MPH, MHA, PharmD, PhD, or equivalent).
- Typically requires 18+ years of healthcare market access experience.
- Demonstrated experience leading commercial payer market access strategies for genomic sequencing, genetic testing, molecular diagnostics, precision medicine, or other advanced diagnostic technologies.
- Direct experience working with national and regional commercial health plans, including medical directors, reimbursement leaders, laboratory benefit managers (LBMs), and payer policy teams.
- Demonstrated success securing or influencing commercial payer coverage, reimbursement, and utilization policies.
- Strong understanding of commercial payer medical policy development, evidence requirements, prior authorization, coding, and reimbursement.
- Excellent strategic planning, executive communication, and cross-functional leadership skills.
- Approximately 30–40% travel.
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