Principal US Market Access and Reimbursement Specialist

Intuitive•Sunnyvale, CA

6d•Remote

About The Position

This is a principal-level individual contributor role responsible for US market access and reimbursement strategy for Intuitive's Future Forward growth platforms in the pre-launch period. The Principal, US Market Access & Reimbursement Strategy works upstream and day to day with Clinical Affairs, Regulatory Affairs, HEOR, Medical Affairs, Business Development, and R&D to define the optimal reimbursement pathway for each platform from first-in-human through launch readiness, and to ensure that clinical study design and regulatory strategy are built with that pathway in mind — weighing trade-offs across coding, coverage, and payment options, and advising senior leaders on the risks, sequencing, and decisions needed to reach commercial viability. The role owns the coding, coverage, and payment intelligence that informs both the platforms currently in development and the technologies under evaluation for incubation, licensing, or partnership. The role is focused on strategy, judgment, and senior-level advisory impact, delivered hands-on rather than through a team. It requires deep working knowledge of the US reimbursement environment: CPT, HCPCS, and ICD-10 coding at a certified coder's level; Medicare coverage and payment methodologies (OPPS, MPFS, IPPS); innovative payment pathways including NTAP, TPT, and NT-APC; provider economics across sites of service, including hospital margin, physician economics, and quality-linked payment programs; and early commercial payer strategy. The successful candidate will have health economics and evidence generation experience, will work independently in the codes and the data, and will present directly to senior management and executives. HEOR builds the economic models and evidence; this role defines what evidence the reimbursement pathway requires, directs that work, and translates it for payers and leadership. The role sits alongside Clinical Affairs and Regulatory Affairs as a standing member of each platform team, contributing to IDE and pivotal study design, endpoint and comparator selection, indication and labeling decisions, and FDA pathway choices wherever they carry coding, coverage, or payment consequences. The US is the primary market; prior international reimbursement or HTA experience is strongly preferred so that US pathway decisions can be read across to global evidence planning.

Requirements

Minimum 15 years of related experience in US market access, reimbursement, coding, or health policy roles within medical device, biotech, consultancy, payer, or hospital settings with a bachelor's degree; or 12 years with a master's degree; or a PhD with 8 years of experience; or an equivalent combination of education and experience.
Bachelor’s degree required; advanced degree (MS, MBA, MPH, PhD, or equivalent) preferred.
AAPC Certified Professional Coder (CPC) or equivalent (COC, CRC, AHIMA CCS) strongly preferred and highly valued; candidates without certification should demonstrate equivalent working fluency in procedural coding and a willingness to obtain CPC within 12 months of hire.
Track record of developing and executing US reimbursement strategy for novel or first-of-kind procedural technologies, from early pipeline through launch, and of personally producing the underlying reimbursement analyses, coding assessments, and payer policy reviews rather than directing a team.
Demonstrated experience with CMS innovative payment pathways (NTAP, TPT, NT-APC), including at least one application taken through to decision.
Experience working directly with Clinical Affairs and Regulatory Affairs on device programs, including contributing reimbursement input to study design, endpoint selection, indication wording, or FDA pathway decisions.
Health economics and evidence generation experience: contributing to budget impact or cost-effectiveness models, shaping clinical or real-world evidence plans to meet payer and CMS requirements, and working with published economic and clinical literature.
Demonstrated track record of executing early payer engagement activities (advisory boards, payer interviews, payer perception research) and KOL engagement in a pre-launch setting.
Experience in a pre-launch or early-pipeline environment where reimbursement strategy had to be built ahead of clinical evidence, ideally taking a procedural technology from feasibility through launch readiness.
Deep fluency in CPT, HCPCS Level II, and ICD-10-CM/PCS coding, with the ability to work in the codes independently at a certified coder's level — crosswalk and analog selection, bundling and modifier logic, NCCI edits, and the reasoning behind how a procedure will actually be coded and billed in practice.
Strong working knowledge of Medicare payment methodologies (OPPS/APC, MPFS/RVU, IPPS/MS-DRG) and rule-making cycles; practical familiarity with commercial payer policy structures, MAC LCDs, and coverage determination processes.
Strong understanding of provider economics, including hospital margin and physician economics by site of service, and how quality-linked payment programs and penalties shape hospital purchasing and adoption decisions.
Working knowledge of FDA device pathways (510(k), De Novo, PMA, Breakthrough Device) and clinical study design fundamentals sufficient to engage credibly with Regulatory and Clinical colleagues and to identify where their decisions affect reimbursement.
Working knowledge of AMCP Format and analogous device/procedural payer dossier conventions, and of how pre-launch evidence plans map to commercial medical policy and prior authorization requirements.
Proven ability to translate HEOR outputs (cost-effectiveness, budget impact, real-world evidence) into payer-digestible narratives and to communicate economic content credibly to medical and pharmacy directors.
Strong written and verbal communication, with proven ability to distill complex reimbursement detail, tailor it to varying audiences, and deliver impactful presentations to senior management and executives.
Independent working style: determines methods and priorities on new assignments, drives results with limited supervision, and can be relied upon to assess known and unknown factors and determine the best way forward for the business, while partnering closely across a global matrix.
Advanced PowerPoint and Excel; comfort with data manipulation and visualization.
US-based; willingness to travel up to 25% domestically for KOL engagements, advisory boards,, and conferences, with occasional international travel.

Nice To Haves

International reimbursement, market access, or HTA experience (e.g., NICE, G-BA, HAS, MHLW/Chuikyo, MSAC) strongly preferred
working familiarity with claims and hospital databases (e.g., Definitive Healthcare) preferred

Responsibilities

Define and own the US reimbursement strategy for each Future Forward growth platform, including pathway selection, sequencing, timelines, and critical dependencies; advise senior leaders on the trade-offs and decision points for programs with ambiguous or novel payment pathways.
Independently conduct detailed analyses of CPT, HCPCS Level II, and ICD-10-CM/PCS code applicability for growth platform procedures, including crosswalk and analog selection, bundling and modifier logic, and NCCI edits, and defend the rationale to internal and external stakeholders.
Track and interpret CMS rule-making cycles (OPPS, MPFS, IPPS proposed and final rules) and translate implications for platform reimbursement.
Analyze APC assignment, RVU values, payment rates, and packaging logic to identify reimbursement risks and opportunities across hospital outpatient, ASC, and physician office settings.
Assess MAC LCDs, NCDs, and commercial payer policies for existing coverage signals and likely coverage barriers relevant to growth platforms ahead of launch.
Lead the development of NTAP, TPT, and NT-APC applications for eligible growth platform technologies.
Monitor CMS pathway eligibility criteria, application windows, and approval precedents to identify strategic opportunities.
Build and maintain reimbursement scenario analyses comparing standard payment versus innovative pathway scenarios.
Track competitor and adjacent-technology applications and outcomes to inform Intuitive’s pathway strategy.
Partner with HEOR colleagues on the evidence requirements that support innovative payment pathway submissions.
Build pre-launch commercial payer landscape assessments across national and regional plans and Medicaid MCOs to establish the likely coverage position at launch.
Design and execute early payer engagement activities — pre-launch advisory boards, payer interviews, mock P&T discussions, and payer perception research — and synthesize findings into actionable input for evidence plans and value story refinement.
Contribute to provider economics analyses across hospital inpatient, outpatient, ASC, and physician settings — hospital margin and contribution analyses, physician payment and RVU economics, cost-to-charge and cost report considerations, and the effect of quality-linked payment programs (e.g., HAC Reduction, HRRP, hospital VBP) on the case for adoption.
Define the evidence needed to support coding, coverage, and payment decisions, and partner with HEOR, Clinical, and epidemiology colleagues to design and scope the studies, registries, and real-world data analyses that generate it.
Direct and critically review HEOR budget impact, cost-consequence, and cost-effectiveness work from a reimbursement perspective, and translate the outputs into provider- and payer-facing economic narratives.
Use claims and hospital databases (e.g., Definitive Healthcare or comparable platforms) where needed to inform procedural volume, site-of-care trends, and payer mix.
Partner with Clinical Affairs on the design of feasibility, IDE, and pivotal studies so that endpoints, comparators, populations, sites of service, and resource-use data capture support future coding, coverage, and payment applications as well as regulatory authorization.
Partner with Regulatory Affairs on indication wording, labeling, device classification, and FDA pathway selection (510(k), De Novo, PMA, Breakthrough Device designation), identifying where regulatory choices determine NTAP, TPT, NT-APC, or CPT eligibility and timing.
Align regulatory, clinical, and reimbursement milestones into a single integrated timeline for each platform, and flag sequencing conflicts (e.g., FDA authorization timing versus CMS application windows) to platform and senior leadership.
Contribute reimbursement input to clinical evidence plans, registries, and post-market study design, and to the clinical sections of coding and payment applications (clinical vignettes, physician work descriptions, resource-use narratives).
Serve as the reimbursement member of cross-functional platform teams, working day to day with Clinical, Regulatory, R&D, and HEOR colleagues rather than as a downstream reviewer.
Lead reimbursement diligence on candidate technologies under evaluation for internal incubation, licensing, partnership, or acquisition — producing structured viability assessments covering coding pathway, payment adequacy, coverage outlook, and innovative payment pathway eligibility.
Serve as a thought partner to Future Forward leadership and Business Development colleagues during early-stage opportunity assessment, surfacing reimbursement risks and opportunities that should inform go/no-go decisions.
Contribute reimbursement perspective to platform-shaping decisions — indication selection, site-of-care strategy, procedural design, and evidence requirements — ensuring payment economics are factored in early rather than retrofitted.
Maintain ongoing competitive and adjacent-technology intelligence, tracking competitor NTAP/TPT/NT-APC applications, recent CMS coverage decisions, CPT Category III activity, and emerging signals on future payment policy.
Prepare and present reimbursement-focused materials and analyses for portfolio reviews, stage-gate meetings, and investment committee discussions.
Engage directly with clinical, coding, and reimbursement KOLs, hospital revenue cycle leaders, and reimbursement consultants to gather real-world coding behavior, claims intelligence, and payer experience.
Lead advisory boards, payer interviews, and coding roundtables — including planning, content development, and synthesis of outputs.
Attend AMA CPT Editorial Panel and RUC meetings and relevant reimbursement-focused conferences (e.g., AdvaMed, AAPC, AHIMA) as required, and contribute to internal debriefs.
Produce clear, well-designed slide decks and written reports for senior Medical Affairs, HEOR, Commercial, and executive audiences; translate complex reimbursement concepts into accessible narratives for non-specialist audiences.
Operating in a global matrix, partner with senior Medical Affairs, HEOR, Clinical, Business Development, Regulatory, and R&D colleagues to ensure reimbursement implications are integrated into platform development and pipeline decisions, and maintain compliance with applicable transparency, anti-kickback, and Medical Affairs interaction frameworks.