Senior, Director, Health Policy & Reimbursement

Key Responsibilities

• Monitor federal and state legislative, regulatory, coding, payment, and coverage developments affecting clinical laboratories, molecular diagnostics, genomics, rare disease, and precision medicine; convert changes into clear enterprise implications and action plans.
• Represent Baylor Genetics in health policy matters with trade associations, standards-setting organizations, public agencies, coalitions, payer policy forums, and other external stakeholders.
• Lead end-to-end coding strategy for new and existing products, including applications for new or revised CPT codes through the American Medical Association and coordination of ICD-10-CM code proposals through the Centers for Disease Control and Prevention and other appropriate federal processes.
• Develop evidence, utilization, clinical-workflow, and economic rationales required to support coding, valuation, coverage, and reimbursement submissions.
• Lead state health policy strategies that accelerate adoption and sustainable funding of rapid WGS for critically ill infants and children, including Medicaid, appropriations, coverage mandates, pilots, and implementation pathways.
• Partner with authorized Government Affairs resources, external coalitions, and registered lobbyists to educate and engage state legislatures and members of the U.S. Congress on Baylor Genetics priorities in accordance with Legal and Compliance requirements.
• Lead upstream pipeline reimbursement planning for new products, platform extensions, and tuck-in acquisitions, including coding, coverage, payment, evidence, channel, operational, and commercialization-readiness assessments.
• Integrate reimbursement and policy diligence into business-development evaluations, identifying access risks, evidence gaps, investment requirements, and post-close integration priorities.
• Guide responses to proposed federal and state rules, payer policies, fee schedules, laboratory payment reforms, and other public-comment opportunities.
• Build executive-ready policy briefs, scenario analyses, risk assessments, and recommendations for senior leadership and the Board, as appropriate.
• Partner with Revenue Cycle and Finance to assess payment adequacy, coding performance, denial patterns, fee-schedule changes, and financial impact.
• Maintain governance, documentation, and compliance controls for policy engagement, coding submissions, coalition activity, and external representation.

People Leadership Responsibilities

• Lead, coach, develop, and retain a team responsible for health policy, coding, reimbursement strategy, and government-affairs coordination.
• Establish measurable objectives, operating rhythms, decision rights, and accountability aligned to enterprise priorities.
• Conduct regular portfolio, policy, and pipeline reviews; remove barriers and ensure timely execution of critical submissions and advocacy initiatives.
• Develop succession plans and expand organizational capability in laboratory policy, coding, payment, and state-government engagement.
• Promote a culture of integrity, evidence-based advocacy, cross-functional partnership, and execution excellence.

Core Deliverables

• Annual federal and state health policy strategy with prioritized issues, stakeholders, risks, and action plans.
• CPT and ICD-10-CM coding roadmaps, applications, evidence packages, and milestone plans for priority products.
• State rWGS adoption strategy, including legislative, Medicaid, appropriations, coalition, and implementation pathways.
• Congressional and state policy engagement plans executed with authorized Government Affairs and Compliance partners.
• Pipeline and acquisition reimbursement-readiness assessments with clear go/no-go considerations and investment requirements.
• Executive dashboards covering policy developments, coding milestones, reimbursement risks, advocacy progress, and expected business impact.

Role Impact

This role shapes the policy, coding, and reimbursement environment required to accelerate rWGS adoption, support product innovation, enable strategic growth, and expand patient access to Baylor Genetics testing.