Director, Commercial Reimbursement - Remote, USA

Summary

The Director of Commercial Reimbursement is responsible for leading Calyxo’s commercial health plan reimbursement strategy and execution. This role has accountability for commercial payer coverage strategy, payer negotiations, and reimbursement operations, including management of the Market Access Manager team. This position also provides leadership and coaching to the Market Access Manager team, ensuring clear priorities, strong execution, and ongoing development of capabilities across the function.

Responsibilities

• Develop and execute commercial reimbursement strategies aligned with company objectives and growth plans.

• Lead engagement with national, regional, and local commercial health plans, including medical directors and policy teams.

• Drive efforts to influence, establish, or revise commercial payer medical policies, including:

  • Challenging non-coverage determinations, including “Investigational and Experimental” designations
  • Addressing restrictive utilization criteria
  • Serving as a subject-matter expert on commercial coverage and payment

• Lead escalation of payer policy disputes and coverage barriers that cannot be resolved through standard operational channels.

• Drive support for efforts to ensure appropriate reimbursement in cases of commercial payer underpayment.

• Provide leadership on payer positioning, value messaging, and reimbursement implications of payer decisions.

• Serve as the primary commercial reimbursement contact for payer negotiations and senior level escalations, including direct engagement with medical directors and payer leadership.

• Coordinate and support peer-to-peer, appeal, and reconsideration efforts involving clinical and provider stakeholders.

• Apply in-depth understanding of commercial payer processes, timelines, and decision-making frameworks.

• Support the identification and development of physician champions to reinforce payer engagement activities.

• Partner with providers to address reimbursement issues across outpatient sites of service.

• Ensure reimbursement strategies align with real-world site-of-care dynamics and provider operational needs.

• Provide direct people management and leadership for the Market Access Manager team.

• Establish and maintain standardized processes, tools, and best practices to ensure consistent field execution.

• Set performance expectations, coach team members, and support ongoing development.

• Serve as the escalation point for complex, high-risk, or precedent setting reimbursement issues with material access, revenue, or policy implications, including direct payer engagement when required.

• Collaborate with Commercial, Sales, Medical Affairs, Legal, Compliance, and Finance teams to ensure integrated reimbursement planning and compliant execution.

• Provide reimbursement guidance to support commercial planning, launch readiness, and field enablement.

• Represent commercial reimbursement perspectives in cross-functional forums and leadership discussions.

Requirements

• Bachelor’s degree required; advanced degree preferred (health policy, health services administration, public health).

• Minimum 8 years of progressively responsible experience, including accountability consistent with a Senior Manager or Director level role, in reimbursement, market access, or payer relations within medical devices or healthcare.

• Demonstrated experience working with commercial health plans, including policy review, coverage advocacy, and payer negotiations.

• Strong working knowledge of commercial health plan prior authorization, claims processing, and appeals in outpatient settings.

• Experience working with commercial payer data sources and claims datasets (e.g., payer policy intelligence platforms or DHC type claims data) to support coverage analysis, denial trends, and reimbursement decision making.

• Familiarity with coding, payment, and site-of-care considerations across multiple care settings.

• Experience partnering with physicians to support payer discussions or appeal strategies.

• Prior people management experience with accountability for team performance and development.

• Ability to effectively interact with multiple departments and functions; manage completion of multiple tasks.

• Ability to prioritize projects and display initiative and flexibility. Detail oriented & strong organizational skills.

• Excellent oral presentation skills via teleconference and in person.

• Strong technical, written and communication skills.

• Proficiency with productivity software including Microsoft Office (Word, Excel, Outlook, PowerPoint etc.).

• Willingness and ability to maintain up-to-date hospital credentialing requirements including all required vaccinations and immunizations.

What We Offer

• A competitive base salary range of $210,000 - $225,000 and variable incentive plan
• Stock options – ownership and a stake in growing a mission-driven company
• Employee benefits package that includes 401(k), healthcare insurance and paid vacation

Legal Authorization

Legal authorization to work in the United States is required. In compliance with federal law, all persons hired will be required to verify their identity and eligibility to work in the United States and to complete the required employment eligibility verification form upon hire.

Disclaimer

At Calyxo, we prioritize a transparent and structured interview process to ensure the best fit for both our candidates and our team. Please be aware of the following:

• Structured Interview Process: Our hiring process includes multiple stages of interviews where you will have the opportunity to communicate directly with Calyxo employees. This ensures that you gain a comprehensive understanding of the role and our company culture.

• Verification of Identity: We do not extend job offers without first meeting candidates, either virtually or in person. This step is crucial to maintain the integrity of our hiring process and to ensure mutual alignment.

• Beware of Scams: Calyxo will never request sensitive personal information, such as your full name, address, phone number, or identification documents, via email or online forms before an official interview. Calyxo representatives will always contact you using an email format of firstname.lastname@calyxoinc.com. If you receive a request for information from any other domain, please contact us directly at info@calyxoinc.com to verify the legitimacy of the communication.