Sr. Director, Field Reimbursement
RemoteUnited States
Job Summary
Build and lead a national team of Field Reimbursement Managers supporting the Retina and Surgical buy-and-bill portfolio. Set the national strategy for field reimbursement support, ensuring physicians and staff navigate coverage, coding, billing, and claims processes with confidence. Define team structure, KPIs, and performance standards while recruiting top talent and fostering cross-functional collaboration with Sales, Marketing, and Legal. Serve as the senior escalation point for complex payer and claims issues, conducting regular business reviews to identify access barriers. Maintain deep expertise in payer dynamics, HCPCS/CPT coding, and claims analytics to translate data insights into targeted field action plans. Own reporting dashboards tracking access metrics and franchise-level reimbursement KPIs while ensuring all activities adhere to compliance policies and OIG guidance.
Required Qualifications
- Bachelor's degree
- 10+ years of progressive experience in market access, reimbursement, or trade, including significant experience in buy-and-bill / specialty pharmaceutical or biotech environments
- 5+ years of people leadership experience, including building and managing field-based reimbursement or access teams
- Deep, demonstrable expertise in payer policy, medical and pharmacy benefit dynamics, coding (CPT/HCPCS/ICD-10), billing workflows, and claims/appeals processes
- Proven ability to conduct and lead claims data analysis to drive business decisions and customer-facing recommendations
- Track record of setting strategy and driving measurable improvements in patient access and reimbursement outcomes
- Strong executive presence; experience presenting to and influencing senior internal and external stakeholders
- Working knowledge of compliance requirements governing reimbursement support programs (PhRMA Code, OIG guidance, anti-kickback considerations)
- Up to 75% travel
Desired Qualifications
- advanced degree (MBA, MHA, or related)
- Experience in Retina, Ophthalmology, or Surgical specialty markets
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