Senior Manager, Operations & Market Access

Position Overview

The Reimbursement Operations & Field Market Access lead is the execution engine of the U.S. HEMA organization. This role is the closest link to the sales and marketing organization and serves as the primary tactical interface with providers, payers, and field teams. This is both a payer-facing and provider-facing role.

On the payer side, this person develops value dossiers, manages payer advisory boards, and supports key account engagement. On the provider side, this person generates billing guides, fields customer reimbursement questions, develops provider education materials, and supports all field logistics related to coding implementation.

In Phase 1, this role carries both midstream and downstream responsibilities—from code acquisition and payment policy implementation through to field collateral generation and customer support. This role carries shared responsibility for midstream/payment policy activities with the Upstream Strategist until a dedicated Midstream hire is made (~18 months).

Core Responsibilities

• Provider-Facing Billing Guide Development: Create, maintain, and distribute comprehensive billing and coding guides for all products. Ensure guides are CPC-reviewed, compliance-approved, and updated with each code cycle.
• Customer Reimbursement Support: Serve as the primary point of contact for management of customer reimbursement vendor(s). Manage vendor, monitor performance, and retain required documentation.
• Code Implementation Logistics: Manage all field logistics associated with the implementation of new or existing CPT, HCPCS, and ICD-10 codes. Coordinate with provider sites to ensure smooth adoption of coding changes and cost capture.
• Sales & Marketing Support: Generate evidence-driven, compliant field collateral in direct support of the sales and marketing organization.
• Payer-Facing Value Dossier Development: Coordinate with Upstream and distribute value dossiers and payer-facing evidence packages that communicate the clinical and economic value of the product portfolio.
• Key Account Management: Manage fractional headcount resources and coordinate payer engagement at key accounts.
• Policy Monitoring & Implementation: Track payer coverage policies, MAC LCDs, and commercial payer guidelines. Translate upstream payment policy developments into actionable field tools and communications.
• Field Personnel Management for Payer Campaigns: Manage and direct field personnel in support of payer-focused campaigns. Coordinate field reimbursement specialists, outsourced resources, and account-level teams to execute payer engagement strategies, coverage initiatives, and pull-through programs at targeted accounts.
• Shared Midstream / Payment Policy Code Acquisition Support: Support CPT/HCPCS code acquisition activities in partnership with the Upstream Strategist, including preparation of supporting materials for AMA and CMS submissions.
• Payment Policy Implementation: Translate CMS OPPS/PFS payment policy changes into operational guidance for the field. Develop communications for code changes, payment updates, and coverage determinations.
• Reimbursement Calculator & Tools: Develop and maintain compliance-accurate reimbursement estimation tools for use by the sales team and provider accounts.

Qualifications

• 4 year degree is required.
• 6+ years of progressive experience in medical device or pharmaceutical reimbursement, field market access, or payer relations
• Direct experience developing billing guides, coding tip sheets, and provider reimbursement education materials
• Strong working knowledge of CPT, HCPCS, ICD-10 coding systems and hospital billing workflows (OPPS, ASC, physician office)
• Experience managing payer relationships, developing value dossiers, and executing advisory boards
• Demonstrated ability to work closely with sales and marketing teams in a commercial support capacity
• Strong project management skills; ability to manage multiple simultaneous deliverables across products
• CPC (Certified Professional Coder) certification strongly preferred
• Experience with field reimbursement team management (outsourced or in-house)
• Familiarity with FCA/AKS compliance requirements for manufacturer-provided reimbursement guidance
• Experience with business intelligence platforms