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Senior Manager, Upstream Reimbursement Strategy

United States · remote · Salary not listed

Role overview

Primary Function of Position
The Upstream Reimbursement Strategist is the architect of the organization’s long-range
reimbursement and market access strategy across the U.S. product portfolio. This person is
responsible for generating all strategies for all upstream programs and dovetailing those strategies
with global market access for ex-U.S. projects. This role is the closest link to the clinical
development team and serves as the primary strategic interface with HEOR, regulatory affairs, and

health policy stakeholders.

Responsible for evidence generation strategy, CPT/HCPCS code pathway design, CMS payment
policy analysis, and the global coordination of evidence that feeds both upstream regulatory
submissions and downstream field execution tools. This person shapes the narrative for why a
product deserves reimbursement and builds the data package to support it.
This role carries shared responsibility for midstream activities (code acquisition, pre-launch payer
engagement) until a dedicated Midstream hire is made (18 months). The strategic upstream work
evidence, coding pathways, payment policy, is the primary focus.

Responsibilities

Reimbursement Evidence Strategy: Partner with HEOR to design, commission, and oversee health economic and outcomes research studies that support reimbursement across the product portfolio.
Ensure evidence generation aligns with regulatory, payer, and provider needs.
Reimbursement Data Collection: In coordination with HEOR, architect the evidence plans for a reimbursed product.
- Oversee collection of that data and packaging into publications (e.g., burden of illness, cost-utility, budget impact) for payer and provider consumption, aligned with the broader payer and provider engagement campaign.
CPT/HCPCS Code Strategy: Lead the strategy for new code applications, Category III code conversions, and descriptor modifications.
- Manage engagement with AMA CPT Editorial Panel, RUC, and HCPCS workgroups.
CMS Payment Policy Analysis: Conduct ongoing analysis of OPPS, PFS, and ASC payment policy.
- Prepare and submit CMS comment letters during rulemaking cycles. Monitor NT-APC, pass-through, and device payment category developments.
Global Evidence Coordination: Serve as the connective tissue between U.S. evidence needs and global HEOR and OUS markets.

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Senior Manager, Upstream Reimbursement Strategy

Role overview

health policy stakeholders.

Responsibilities

Required Qualifications

Preferred