The Director, Market Access - CMS Coverage & Reimbursement Policy will lead the company's strategy for Medicare coverage, coding, reimbursement, and federal payment policy affecting genomic sequencing and genetic testing. This individual will serve as the company's primary expert on CMS coverage policy, Medicare Administrative Contractors (MACs), coding processes, reimbursement methodologies, and federal regulatory developments impacting access to genomic sequencing and genetic testing.
Working closely with Government Affairs, Medical Affairs, HEOR, Clinical Affairs, Regulatory Affairs, and Commercial teams, this leader will develop evidence-based strategies that improve Medicare beneficiary access while shaping national reimbursement policy.
Responsibilities- Lead Medicare market access strategies for genomic sequencing and genetic testing.
- Develop strategies for NCDs, LCDs, MolDx, MAC engagement, CLFS pricing, CPT/PLA coding, and reimbursement.
- Monitor CMS rulemaking and federal reimbursement policy developments.
- Partner with Government Affairs on federal advocacy and policy initiatives.
- Collaborate with Medical Affairs and HEOR to develop evidence supporting Medicare coverage.
- Represent the company with CMS, Medicare contractors, and industry organizations.
Requirements- Bachelor's degree required; advanced degree preferred (MPH, MHA, PharmD, PhD, JD, MBA, or equivalent).
- 10+ years of experience in Medicare reimbursement, federal health policy, or market access.
- Demonstrated experience leading Medicare coverage and reimbursement strategies for genomic sequencing, genetic testing, molecular diagnostics, precision medicine, or other advanced diagnostic technologies.
- Over 5 years of direct experience working with CMS, Medicare Administrative Contractors (MACs), MolDx, or other Medicare reimbursement and policy organizations. Ideal candidates would have worked at CMS.
- Demonstrated success influencing Medicare coverage, coding, pricing, or reimbursement policy.
- Deep knowledge of NCDs, LCDs, CLFS, CPT and PLA coding, gapfill and crosswalk pricing, and Medicare payment policy.
- Excellent policy analysis, stakeholder engagement, and executive communication skills.
TravelApproximately 25-35% travel.
The estimated base salary range for the Director, Market Access - CMS Coverage & Reimbursement Policy role based in the United States of America is: $187,400 - $281,000. Should the level or location of the role change during the hiring process, the applicable base pay range may be updated accordingly. The range reflects long-term growth in the role; therefore, most candidates are hired between the minimum and middle of the range. Placement depends on experience, skills, location, and internal equity. Additionally, all employees are eligible for one of our variable cash programs (bonus or commission) and eligible roles may receive equity as part of the compensation package. We offer a wide range of benefits as innovative as our work, including access to genomics sequencing, family planning, health/dental/vision, retirement benefits, and paid time off.
