Senior Manager, Upstream Reimbursement Strategy

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

📋 Description

• The Upstream Reimbursement Strategist serves as the architect for the organization’s long-term reimbursement and market access strategy across the U.S. product portfolio.

• Accountable for developing comprehensive strategies for all upstream programs and aligning them with global market access for international projects.

• Craft the narrative that justifies reimbursement for a product and compile the necessary data package to support this initiative.

• Collaborate with HEOR to design, commission, and supervise health economic and outcomes research studies that bolster reimbursement across the product range.

• Ensure that evidence generation is in line with the requirements of regulatory bodies, payers, and providers.

• Spearhead the strategy for new code applications, conversions of Category III codes, and modifications to descriptors.

• Perform continuous analysis of OPPS, PFS, and ASC payment policies.

• Act as the link between U.S. evidence needs and global HEOR as well as OUS markets.

• Develop and oversee the reimbursement strategy for all upstream initiatives throughout the entire product portfolio.

⛳️ Requirements

• Bachelor’s degree.

• Over 8 years of progressive experience in medical device market access, health economics, reimbursement strategy, or a related field.

• In-depth understanding of CMS OPPS/PFS/ASC payment systems, APC mechanics, and facility payment methodologies.

• Familiarity with CPT code applications, processes of the AMA Editorial Panel, and HCPCS coding pathways.

• Proven expertise in evidence generation, real-world evidence study design, and health economic modeling.

• Strong analytical capabilities with experience in interpreting claims data, cost reports, and CMS rulemaking documents.

• Ability to collaborate effectively across clinical, regulatory, HEOR, and commercial teams.

🏝️ Benefits

• Health insurance.

• 401(k) matching.

• Paid time off.

• Flexible work arrangements.

• Opportunities for professional development.