Director of MCO & Market Access

Job Details Description Core Competencies Market Access Strategy — Develops and executes payer strategies that expand appropriate patient access, improve reimbursement, and support commercial growth.Payer & Reimbursement Expertise — Interprets coverage policy, medical necessity criteria, prior authorization requirements, coding, reimbursement methodologies, and claims processes.Payer Contracting & Relationships — Builds productive relationships with commercial health plans, Medicare Advantage organizations, Medicaid managed care organizations, medical directors, and network teams.Commercial & Financial Acumen — Evaluates payer opportunities using covered lives, order volume, conversion, reimbursement economics, denial trends, revenue potential, and profitability.Analytical Decision-Making — Uses payer, claims, reimbursement, provider, and market data to prioritize opportunities and measure impact.Field Enablement — Converts payer requirements into clear coverage guidance, documentation expectations, authorization pathways, reimbursement tools, and actionable direction for the field.Cross-Functional Influence — Aligns Sales, Commercial Operations, Revenue Cycle, Clinical, Finance, Legal, Compliance, and executive stakeholders around payer priorities and execution.Executive Communication & Accountability — Simplifies complex market access issues into business implications, recommendations, measurable objectives, and clear progress updates. Essential Duties & Responsibilities Commercial Payer Strategy & Market Access Develop and execute national and regional commercial payer strategies to expand access and improve reimbursement across Altivera’s product portfolio.Identify and prioritize payer opportunities using covered lives, patient populations, reimbursement economics, order volume, denial trends, geographic opportunity, and strategic importance.Build payer-specific strategies addressing coverage policy, network participation, contracting, prior authorization, medical necessity, reimbursement levels, and claims requirements.Maintain a prioritized payer opportunity pipeline with defined strategies, milestones, ownership, expected financial impact, and progress toward resolution. Coverage Policy, Reimbursement & Contracting Monitor payer medical policies, coverage criteria, reimbursement methodologies, coding requirements, authorization requirements, and policy changes affecting Altivera therapies.Develop evidence-based strategies to establish, expand, or protect favorable coverage for NMES, IFC, TENS, and future therapies, partnering with Clinical, Legal, Compliance, and other stakeholders as appropriate.Lead or support payer contracting and network-access initiatives; evaluate proposed agreements based on reimbursement, patient access, administrative requirements, operational complexity, and expected financial contribution.Maintain current reimbursement intelligence for key HCPCS codes, payer segments, and geographic markets. Commercial Enablement & Market Analytics Translate payer policies and reimbursement requirements into clear field guidance, including coverage summaries, documentation requirements, authorization pathways, reimbursement updates, and objection-handling resources.Partner with Sales Training and Commercial Operations to educate field teams on payer access, documentation requirements, reimbursement pathways, and material policy changes.Develop payer opportunity assessments and performance views incorporating access, claims, conversion, reimbursement, denials, provider concentration, historical performance, and profitability.Quantify the expected impact of payer opportunities and recommend where the organization should invest resources across contracting, policy development, documentation improvement, field targeting, and reimbursement initiatives. Cross-Functional Leadership & Execution Serve as the commercial subject matter expert for payer access and reimbursement and provide executive leadership with clear visibility into opportunities, risks, progress, and financial impact.Partner with Revenue Cycle to understand claims performance, denials, appeals, reimbursement, and operational barriers and convert those insights into payer strategies.Partner with Sales and Commercial Operations to identify payer barriers, prioritize markets, and translate access improvements into field execution and growth opportunities.Partner with Clinical, Finance, Legal, and Compliance to align payer strategy with clinical evidence, reimbursement economics, contractual requirements, and applicable compliance standards. Experience & Education Bachelor’s degree in Business, Healthcare Administration, Health Economics, Finance, Life Sciences, or related field required.Seven (7)+ years of progressive experience in market access, managed care, reimbursement, payer contracting, revenue cycle, or commercial healthcare strategy.Strong understanding of commercial insurance, Medicare Advantage, Medicaid managed care, healthcare reimbursement, medical policies, benefit structures, prior authorization, medical necessity, and reimbursement methodologies.Demonstrated experience developing payer strategies that improve patient access, reimbursement performance, or commercial outcomes.Strong analytical capability with the ability to translate claims, reimbursement, payer, and financial data into actionable commercial strategies.Demonstrated ability to lead cross-functional initiatives involving Sales, Revenue Cycle, Finance, Legal, Compliance, Clinical, and executive stakeholders.Strong executive communication, negotiation, presentation, and relationship-management skills.Experience in DME, medical device, rehabilitation, orthopedics, pain management, musculoskeletal care, or home-based medical technologies preferred.Experience with HCPCS coding, DME reimbursement, payer contracting, network development, or established managed-care relationships preferred. Success Measures Patient Access — Expands covered lives and improves access to appropriate Altivera therapies across priority payer segments.Payer Performance — Delivers measurable improvements in payer-specific order-to-shipment conversion, authorization approval, denial rates, and clean order/claim performance.Reimbursement Economics — Improves reimbursement performance and payer-level profitability through targeted access and contracting initiatives.Commercial Impact — Generates measurable incremental revenue and growth attributable to payer access improvements and reduced reimbursement barriers.Payer Strategy Execution — Maintains a prioritized opportunity roadmap and demonstrates progress against defined payer strategies, milestones, and financial impact.Field Enablement — Provides accurate, actionable payer intelligence that is consistently adopted across Sales and Commercial Operations.Cross-Functional Alignment — Strengthens coordination among Sales, Commercial Operations, Revenue Cycle, Clinical, Finance, Legal, Compliance, and executive leadership around market access priorities.