Director, Commercial Reimbursement

Calyxo, Inc.

Director of Commercial Reimbursement at Calyxo overseeing payer coverage strategies and reimbursement operations. Engaging with health plans and leading the Market Access Manager team for effective execution.

Posted 5/15/2026full-timeRemote • 🇺🇸 United StatesLead💰 $210,000 - $225,000 per yearWebsite

About the role

Key responsibilities & impact

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
Supporting appropriate coverage pathways
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
Develop metrics and reporting to assess reimbursement performance and identify areas of risk or opportunity
Use payer policy data and claims insights to inform strategic prioritization, escalation decisions, and payer engagement strategies, including identification of issues requiring senior level intervention
Drive continuous improvement in reimbursement strategy and operational effectiveness using data informed insights

Requirements

What you’ll need

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‑service 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
Travel: up to 40%
Work location: Remote
Full time employment
Must be able to sit for up to 8 hours/day

Benefits

Comp & perks

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

ATS Keywords

✓ Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

reimbursement strategiespayer negotiationscoverage advocacyclaims processingprior authorizationpayer policy analysisdata analysismetrics developmentoperational effectivenesshealth policy

Soft Skills

leadershipteam managementorganizational skillscommunication skillspresentation skillsflexibilityinitiativedetail orientedcollaborationproblem-solving