Healthcare Market Access Counsel

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee legal strategy and deliver senior-level counsel on payer contracting, reimbursement, coverage, and broader market access issues.

• Take charge of reviewing, drafting, and negotiating intricate agreements with private payors, commercial insurers, and managed care organizations independently.

• Provide guidance to Market Access and senior business leaders regarding payer strategy, reimbursement frameworks, coverage initiatives, and market access risks and opportunities.

• Convert complex legal and regulatory requirements into actionable business recommendations.

• Lead legal support for reimbursement strategies and appeals processes.

• Counsel on compliance with federal and state healthcare laws, regulations, and guidance related to billing, coding, reimbursement, payer contracting, and coverage.

• Assess payer policies, coverage determinations, reimbursement criteria, and contractual provisions to identify legal, regulatory, and business risks.

• Shape cross-functional decision-making through pragmatic legal advice.

• Create legal frameworks, playbooks, contracting positions, templates, and scalable processes.

• Provide guidance and training on payer contracting, reimbursement requirements, healthcare regulatory updates, and market access considerations.

• Keep track of changes in the healthcare legal and regulatory landscape, including PAMA, defrayal obligations, and state biomarker coverage legislation.

• Collaborate with Legal and Compliance leadership on complex or high-risk issues and escalate matters as needed.

• Offer leadership and subject-matter expertise in healthcare, reimbursement, payer contracting, and market access.

• Work cooperatively in alignment with company values.

⛳️ Requirements

• Juris Doctor (JD) from an accredited law school with active bar membership in good standing.

• Over 5 years of pertinent legal experience, particularly in healthcare law, market access, or payer contracting.

• Proven experience in reviewing and negotiating contracts with private payors, health plans, or managed care organizations.

• Strong comprehension of U.S. healthcare reimbursement and coding systems, including commercial insurance and managed care frameworks, the MolDx program, AMA CPT codes, and the CLFS.

• Demonstrated experience in supporting or advising on appeals strategies, coverage disputes, or reimbursement issues.

• Capability to translate complex legal and regulatory matters into clear, actionable guidance for business partners.

• Excellent collaboration and communication skills, with a successful track record of working effectively across cross-functional teams.

• High integrity, sound judgment, and attention to detail.

• Preferred experience in diagnostics, life sciences, or laboratory services environments.

• Familiarity with payer policy development, utilization management, or claims adjudication processes is preferred.

• Preferred experience working closely with market access, billing, revenue cycle, or reimbursement teams.

• Knowledge of federal and state healthcare regulations affecting diagnostics and coverage is preferred.

• Prior in-house experience in a growth-oriented healthcare or biotech organization or a commercial insurance company is preferred.

• Comfort in navigating ambiguity and contributing to evolving processes in a dynamic, mission-driven environment is preferred.

🏝️ Benefits

• Competitive compensation and benefits.

• Potential eligibility for discretionary bonuses/incentives.

• Potential eligibility for restricted stock units.

• Inclusive workforce and workplace culture.

• Opportunities for career advancement and professional growth in a purpose-driven environment.

• Great Place to Work-certified workplace.