Senior Director, Health Policy & Reimbursement

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

📋 Description

• Oversee legislative, regulatory, coding, payment, and coverage developments at both federal and state levels that impact clinical laboratories, molecular diagnostics, genomics, rare diseases, and precision medicine.

• Convert policy alterations into actionable enterprise implications and strategic plans.

• Act as a representative for Baylor Genetics in health policy discussions with trade associations, standards-setting bodies, public agencies, coalitions, payer policy forums, and other external stakeholders.

• Spearhead comprehensive coding strategies for products, including CPT applications with the American Medical Association and ICD-10-CM proposals through the CDC and other federal procedures.

• Create evidence, utilization, clinical workflow, and economic rationales to support coding, valuation, coverage, and reimbursement submissions.

• Drive state health policy initiatives to promote the adoption and sustainable funding of rapid whole genome sequencing (WGS) for critically ill infants and children.

• Collaborate with Government Affairs, external coalitions, and registered lobbyists to interact with state legislatures and members of Congress.

• Oversee reimbursement planning for new products, platform extensions, and tuck-in acquisitions.

• Incorporate reimbursement and policy due diligence into business development assessments.

• Lead responses to proposed regulations, payer policies, fee schedules, laboratory payment reforms, and public-comment opportunities.

• Develop policy briefs, scenario analyses, risk assessments, and recommendations for senior leadership and the Board.

• Partner with Revenue Cycle and Finance to evaluate payment adequacy, coding performance, denial rates, fee schedule adjustments, and financial implications.

• Ensure governance, documentation, and compliance standards are maintained for policy engagement, coding submissions, coalition activities, and external representation.

• Lead, mentor, develop, and retain a team focused on health policy, coding, reimbursement strategy, and government affairs coordination.

• Establish objectives, operational rhythms, decision rights, and accountability in alignment with enterprise goals.

• Conduct reviews of portfolios, policies, and pipelines; eliminate obstacles and guarantee timely execution.

• Formulate succession plans and enhance organizational capability in laboratory policy, coding, payment, and state government engagement.

• Advocate for integrity, evidence-based advocacy, cross-functional collaboration, and execution excellence.

• Provide federal and state health policy strategies, coding roadmaps, rapid WGS adoption strategies, policy engagement plans, reimbursement-readiness assessments, and executive dashboards.

⛳️ Requirements

• Bachelor’s degree in Health Policy, Public Health, Life Sciences, Business, Healthcare Administration, Health Economics, or a related discipline.

• A minimum of 7 years of experience leading teams in health policy and reimbursement.

• At least 12 years of progressive experience in conjunction with the specified qualifications.

• Over 8 years of progressive experience in health policy, reimbursement, coding, government affairs, market access, or similar healthcare leadership roles.

• More than 8 years of direct experience in laboratory health policy and reimbursement, ideally in molecular diagnostics, genomics, or precision medicine.

• Proven experience in leading CPT coding strategy and familiarity with ICD-10-CM coordination and federal coding processes.

• Documented success in influencing state or federal health policy, reimbursement, Medicaid, or legislative initiatives through compliant advocacy and coalition engagement.

• Experience in leading and developing teams focused on policy, coding, reimbursement, or government affairs.

• Ability to interpret legislation, regulations, coding guidance, payment policies, and payer requirements, translating them into strategic business approaches.

• Excellent executive-level communication, storytelling, negotiation, and cross-functional influence skills.

• Willingness to travel approximately 40–50% domestically.

• Preferred: MBA, MPH, MHA, JD, MS, PharmD, PhD, or an equivalent advanced degree.

• Preferred experience with rapid WGS, whole genome sequencing (WGS), whole exome sequencing (WES), next-generation sequencing (NGS), rare diseases, oncology genomics, reproductive genetics, or pediatric critical care.

• Preferred familiarity with AMA CPT processes, CMS payment systems, state Medicaid programs, and CDC ICD-10-CM coordination processes.

• Preferred established relationships with laboratory trade associations, patient advocacy organizations, state policy coalitions, federal agencies, and legislative stakeholders.

• Preferred experience in supporting product pipeline strategy, licensing, mergers and acquisitions, or post-acquisition integration.

• Preferred experience in developing public-comment letters, legislative language, fiscal-impact analyses, or reimbursement evidence packages.

🏝️ Benefits

• An equal opportunity employer dedicated to fostering an inclusive and diverse workplace.

• Reasonable accommodation provided during the application process.

• Remote work arrangements available.