Director - Payor Relations and Reimbursement

PURPOSE OF JOB

The Payor Relations Director will lead all efforts to drive reimbursement coverage and policy, payor engagement, and coverage expansion for a portfolio of innovative ophthalmic medical devices and technologies.

This individual will be responsible for cultivating strategic relationships with commercial and government payors, especially medical directors, and will play a pivotal role in ensuring broad and sustainable patient access.

The Payor Relations Director will also collaborate with Marketing, Medical Affairs, R&D, and Clinical teams to ensure market access and competitive advantage of Sight Sciences products, by developing and executing strategies that integrate health economics, outcomes research and market access solutions across all stages of the product lifecycle

MAJOR DUTIES AND RESPONSIBILITIES



* Develop and execute payor strategy to achieve positive coverage, coding, and reimbursement for ophthalmic devices, with a focus on both new and existing technologies. 


* Build and maintain trusted relationships with key decision-makers at health plans—including Chief Medical Officers, Medical Directors, and Policy Teams—to influence clinical policy and coverage decisions.


* Lead direct engagements with payor medical directors, providing clinical, economic, and outcomes-based evidence that supports the value of ophthalmic interventions.


* Collaborate closely with Clinical, HEOR, and Medical Affairs teams to develop and present compelling clinical dossiers, value propositions, and real-world evidence tailored to ophthalmology payors.


* Support coding initiatives including CPT and HCPCS applications, working with professional societies and coding consultants as needed.


* Monitor and interpret changes in payor policies, CMS coverage decisions, and ophthalmology-specific reimbursement trends that impact product access.


* Partner with field reimbursement and sales teams to troubleshoot local access barriers and identify opportunities for payor advocacy.


* Contribute to pricing strategy and launch planning by delivering payor insights and forecasting reimbursement uptake across segments.


* Act as the voice of the payor within cross-functional planning, ensuring access considerations are integrated into business decisions.

QUALIFICATIONS



* EDUCATION REQUIREMENTS
+ Bachelor’s degree in a HEMA related discipline in health economics, outcomes research or healthcare related field or equivalent experience required.


* EXPERIENCE REQUIREMENTS
+ 8+ years of progressive experience in payor relations, market access, or reimbursement in the medical device or biopharma industry; at least 3+ years focused on ophthalmology or a related specialty.



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+ Demonstrated success in negotiating with and influencing payor medical directors, particularly for specialty medical technologies.
+ Deep understanding of reimbursem...