Director, Market Access – CMS Coverage & Reimbursement Policy

This is a fully remote position, open to applicants in District of Columbia, +1 more state.

📋 Description

• Direct Medicare market access initiatives for genomic sequencing and genetic testing.

• Formulate strategies for NCDs, LCDs, MolDx, MAC engagement, CLFS pricing, CPT/PLA coding, and reimbursement.

• Keep abreast of CMS rulemaking and advancements in federal reimbursement policies.

• Collaborate with Government Affairs on federal advocacy and policy endeavors.

• Work alongside Medical Affairs and HEOR to create evidence that supports Medicare coverage.

• Act as the company’s representative with CMS, Medicare contractors, and industry organizations.

• Function as the primary expert on CMS coverage policies, Medicare Administrative Contractors, coding protocols, reimbursement methods, and federal regulatory changes that impact genomic sequencing and genetic testing.

• Engage with Government Affairs, Medical Affairs, HEOR, Clinical Affairs, Regulatory Affairs, and Commercial teams to influence national reimbursement policies.

⛳️ Requirements

• Bachelor's degree is required; an advanced degree is preferred (MPH, MHA, PharmD, PhD, JD, MBA, or equivalent).

• Over 10 years of experience in Medicare reimbursement, federal health policy, or market access.

• Proven track record in leading Medicare coverage and reimbursement strategies for genomic sequencing, genetic testing, molecular diagnostics, precision medicine, or other advanced diagnostic technologies.

• More than 5 years of hands-on experience working with CMS, Medicare Administrative Contractors (MACs), MolDx, or similar Medicare reimbursement and policy organizations.

• Demonstrated ability to influence Medicare coverage, coding, pricing, or reimbursement policies effectively.

• Extensive knowledge of NCDs, LCDs, CLFS, CPT and PLA coding, gapfill and crosswalk pricing, and Medicare payment policy.

• Exceptional skills in policy analysis, stakeholder engagement, and executive communication.

• Willingness to travel approximately 25–35% of the time.

• This position is not eligible for visa sponsorship.

🏝️ Benefits

• Variable cash program (bonus or commission).

• Equity options for eligible positions.

• Access to genomic sequencing.

• Family planning benefits.

• Comprehensive health, dental, and vision coverage.

• Retirement benefits.

• Paid time off.

• Employee Resource Groups providing career development experiences, cultural awareness, and opportunities for social responsibility.