Director, Commercial Reimbursement - Remote, USA

Summary

The Director of Commercial Reimbursement is responsible for leading Calyxo’s commercial health plan reimbursement strategy and execution. This role has accountability for commercial payer coverage strategy, payer negotiations, and reimbursement operations, including management of the Market Access Manager team. This position also provides leadership and coaching to the Market Access Manager team, ensuring clear priorities, strong execution, and ongoing development of capabilities across the function.

The position requires a balance of strategic payer engagement and oversight of reimbursement execution, with direct involvement in high‑impact or escalated coverage or payment challenges, policy appeals, claim denials, and provider support requiring senior‑level payer engagement or cross‑functional coordination. The Director will act as a subject‑matter expert on commercial coverage and payment and serve as a key partner to Commercial, Medical, and Sales leadership.

In This Role, You Will:

Commercial Payer Strategy and Policy Management

• 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.

Payer Negotiations and External Engagement

• 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.

Physician and Provider Engagement

• 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.

Reimbursement Operations and Team Leadership

• 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 and ensure team accountability.