Director of MCO & Market Access

Core Competencies

• Market Access Strategy — Develops and executes payer strategies that expand appropriate patient access, improve reimbursement, and support commercial growth.
• Payer & Reimbursement Expertise — Interprets coverage policy, medical necessity criteria, prior authorization requirements, coding, reimbursement methodologies, and claims processes.
• Payer Contracting & Relationships — Builds productive relationships with commercial health plans, Medicare Advantage organizations, Medicaid managed care organizations, medical directors, and network teams.
• Commercial & Financial Acumen — Evaluates payer opportunities using covered lives, order volume, conversion, reimbursement economics, denial trends, revenue potential, and profitability.
• Analytical Decision-Making — Uses payer, claims, reimbursement, provider, and market data to prioritize opportunities and measure impact.
• Field Enablement — Converts payer requirements into clear coverage guidance, documentation expectations, authorization pathways, reimbursement tools, and actionable direction for the field.
• Cross-Functional Influence — Aligns Sales, Commercial Operations, Revenue Cycle, Clinical, Finance, Legal, Compliance, and executive stakeholders around payer priorities and execution.
• Executive Communication & Accountability — Simplifies complex market access issues into business implications, recommendations, measurable objectives, and clear progress updates.

Essential Duties & Responsibilities

Commercial Payer Strategy & Market Access

• Develop and execute national and regional commercial payer strategies to expand access and improve reimbursement across Altivera’s product portfolio.
• Identify and prioritize payer opportunities using covered lives, patient populations, reimbursement economics, order volume, denial trends, geographic opportunity, and strategic importance.
• Build payer-specific strategies addressing coverage policy, network participation, contracting, prior authorization, medical necessity, reimbursement levels, and claims requirements.
• Maintain a prioritized payer opportunity pipeline with defined strategies, milestones, ownership, expected financial impact, and progress toward resolution.

Coverage Policy, Reimbursement & Contracting

• Monitor payer medical policies, coverage criteria, reimbursement methodologies, coding requirements, authorization requirements, and policy changes affecting Altivera therapies.
• Develop evidence-based strategies to establish, expand, or protect favorable coverage for NMES, IFC, TENS, and future therapies, partnering with Clinical, Legal, Compliance, and other stakeholders as appropriate.
• Lead or support payer contracting and network-access initiatives; evaluate proposed agreements based on reimbursement, patient access, administrative requirements, operational complexity, and expected financial contribution.
• Maintain current reimbursement intelligence for key HCPCS codes, payer segments, and geographic markets.

Commercial Enablement & Market Analytics

• Translate payer policies and reimbursement requirements into clear field guidance, including coverage summaries, documentation requirements, authorization pathways, reimbursement updates, and objection-handling resources.
• Partner with Sales Training and Commercial Operations to educate field teams on payer access, documentation requirements, reimbursement pathways, and material policy changes.
• Develop payer opportunity assessments and performance views incorporating access, claims, conversion, reimbursement, denials, provider concentration, historical performance, and profitability.
• Quantify the expected impact of payer opportunities and recommend where the organization should invest resources across contracting, policy development, documentation improvement, field targeting, and reimbursement initiatives.

Cross-Functional Leadership & Execution

• Serve as the commercial subject matter expert for payer access and reimbursement and provide executive leadership with clear visibility into opportunities, risks, progress, and financial impact.
• Partner with Revenue Cycle to understand claims performance, denials, appeals, reimbursement, and operational barriers and convert those insights into payer strategies.
• Partner with Sales and Commercial Operations to identify payer barriers, prioritize markets, and translate access improvements into field execution and growth opportunities.
• Partner with Clinical, Finance, Legal, and Compliance to align payer strategy with clinical evidence, reimbursement economics, contractual requirements, and applicable compliance standards.

Experience & Education

• Bachelor’s degree in Business, Healthcare Administration, Health Economics, Finance, Life Sciences, or related field required.
• Seven (7)+ years of progressive experience in market access, managed care, reimbursement, payer contracting, revenue cycle, or commercial healthcare strategy.
• Strong understanding of commercial insurance, Medicare Advantage, Medicaid managed care, healthcare reimbursement, medical policies, benefit structures, prior authorization, medical necessity, and reimbursement methodologies.
• Demonstrated experience developing payer strategies that improve patient access, reimbursement performance, or commercial outcomes.
• Strong analytical capability with the ability to translate claims, reimbursement, payer, and financial data into actionable commercial strategies.
• Demonstrated ability to lead cross-functional initiatives involving Sales, Revenue Cycle, Finance, Legal, Compliance, Clinical, and executive stakeholders.
• Strong executive communication, negotiation, presentation, and relationship-management skills.
• Experience in DME, medical device, rehabilitation, orthopedics, pain management, musculoskeletal care, or home-based medical technologies preferred.
• Experience with HCPCS coding, DME reimbursement, payer contracting, network development, or established managed-care relationships preferred.

Success Measures

• Patient Access — Expands covered lives and improves access to appropriate Altivera therapies across priority payer segments.
• Payer Performance — Delivers measurable improvements in payer-specific order-to-shipment conversion, authorization approval, denial rates, and clean order/claim performance.
• Reimbursement Economics — Improves reimbursement performance and payer-level profitability through targeted access and contracting initiatives.
• Commercial Impact — Generates measurable incremental revenue and growth attributable to payer access improvements and reduced reimbursement barriers.
• Payer Strategy Execution — Maintains a prioritized opportunity roadmap and demonstrates progress against defined payer strategies, milestones, and financial impact.
• Field Enablement — Provides accurate, actionable payer intelligence that is consistently adopted across Sales and Commercial Operations.
• Cross-Functional Alignment — Strengthens coordination among Sales, Commercial Operations, Revenue Cycle, Clinical, Finance, Legal, Compliance, and executive leadership around market access priorities.