Senior Manager, Upstream Reimbursement Strategy

Intuitive•Sunnyvale, CA

About The 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.

Requirements

4 year degree.
8+ years of progressive experience in medical device market access, health economics, reimbursement strategy, or related field
Deep working knowledge of CMS OPPS/PFS/ASC payment systems, APC mechanics, and facility payment methodology
Experience with CPT code applications, AMA Editorial Panel processes, and HCPCS coding pathways
Demonstrated expertise in evidence generation, RWE study design, and health economic modeling
Strong analytical skills with experience interpreting claims data, cost reports, and CMS rulemaking documents
Ability to work cross-functionally with clinical, regulatory, HEOR, and commercial teams

Nice To Haves

A health policy degree or similar is a big plus
Excellent written and verbal communication skills; ability to translate complex policy into strategic recommendations
Advanced degree (MPH, MBA, or equivalent; PhD or PharmD also welcome)
Familiarity with healthcare data platforms
Familiarity with HEOR models

Responsibilities

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.
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.
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.
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.
Serve as the connective tissue between U.S. evidence needs and global HEOR and OUS markets. Dovetail U.S. upstream strategies with global market access to ensure alignment on ex-U.S. projects. Ensure evidence generation is sequenced to serve both U.S. regulatory/payer needs and ex-U.S. HTA submissions, coordinating timing and deliverables across jurisdictions.
Generate and own the reimbursement strategy for all upstream programs across the full product portfolio. Develop and maintain the strategic reimbursement roadmap from early pipeline through commercialization, including target product profiles (TPPs) and core value dossiers (CVDs) for pipeline assets. Identify coverage gaps, analyze competitive reimbursement positioning, recommend pathway strategies, and ensure strategic continuity as products progress through development milestones.
Play a supporting role to HEOR in ensuring the U.S. Market Access team has secured the database resources required to execute strategy and implement the recommendations set out in the U.S. Value Plan.
Monitor competitor reimbursement strategies, code applications, pass-through approvals, and coverage determinations. Translate competitive intelligence into actionable strategic recommendations.
Serve as the primary owner of product positioning in coordination with select downstream stakeholders, ensuring messaging is consistent across other stakeholders in the organization ,particularly when producing publications such as burden of illness, cost-utility, and budget impact analyses.
Serve as the primary reimbursement strategy interface with clinical development, medical affairs, and regulatory affairs. Advise on trial design considerations that support future reimbursement endpoints.
Lead market access research to support value messaging, including claims analyses and where needed coordination of payer interviews, provider interviews, and other primary research.
Lead early payer advisory boards and simulated HTA exercises (e.g., NICE, ICER) to pressure-test clinical and economic evidence packages pre- filing, and translate insights into evidence and positioning adjustments.
Until a dedicated Midstream hire is made, contribute to code acquisition execution, pre-launch payer engagement planning, and payment policy implementation activities in partnership with the Mid/Downstream Tactician.