The Director, Payer Relations – Regional is responsible for developing and executing regional payer engagement and coverage strategy for the TearCare® System. The role builds sustained relationships with Medicare Administrative Contractors, regional commercial health plans, Blue Cross and Blue Shield plans, Medicaid organizations, integrated delivery networks, and other healthcare decisionmakers to advance appropriate patient access and establish clear, evidence based coverage policies.
This leader translates national Market Access priorities into focused regional plans, leads payer discussions regarding TearCare clinical evidence, coding, coverage, and payment, and coordinates cross-functional resources to address policy barriers. The Director serves as the regional payer-relations lead and is accountable for developing engagement plans, monitoring policy activity, preparing coverage submissions, and communicating actionable payer insights to executive and commercial leadership.
MAJOR DUTIES AND RESPONSIBILITIES
Develop and execute a regional payer-relations strategy for TearCare aligned with Market Access, commercial, clinical, medical, legal, and compliance priorities.
Prioritize regional payer organizations based on patient impact, policy opportunity, access barriers, provider needs, and business priorities; maintain account-specific engagement and coverage plans.
Build and maintain professional relationships with payer medical directors, policy leaders, reimbursement teams, provider-relations leaders, pharmacy or technology assessment committees where applicable, and other economic decisionmakers.
Lead compliant payer meetings and discussions focused on TearCare clinical evidence, patient population, treatment pathway, coding, coverage, payment, health-economic considerations, and provider experience.
Monitor existing and emerging payer coverage policies, medical policies, clinical criteria, technology assessments, coding edits, prior-authorization requirements, and reimbursement practices affecting TearCare.
Develop and coordinate payer coverage submissions, reconsideration requests, evidence dossiers, policy comment letters, and follow-up responses using approved clinical, economic, coding, and reimbursement materials.
Engage Medicare Administrative Contractors and other government payer stakeholders within the assigned region regarding coverage, coding, payment, claims experience, and provider-access barriers in accordance with applicable requirements.
Partners with Medical Affairs, Clinical, Health Economics and Outcomes Research, Regulatory, Legal, and Compliance to identify evidence needs and ensure payer communications are accurate, balanced, appropriately substantiated, and compliant.
Convert payer feedback and policy trends into clear recommendations for evidence generation, publication strategy, value messaging, reimbursement tools, provider education, and account prioritization.
Coordinate with Field Reimbursement Managers and Sales leadership to identify regional access barriers, distinguish account-level reimbursement issues from payer-policy issues, and establish appropriate escalation and follow-up pathways.
Provide payer-policy interpretation and strategic guidance to internal stakeholders while avoiding guarantees of coverage or payment and preserving payer-specific nuance.
Create executive-ready regional updates that summarize payer engagement, policy status, open barriers, opportunities, risks, decisions needed, and next actions.
Represent Sight Sciences at payer meetings, medical society discussions, healthcare policy forums, and other relevant external engagements as assigned.
Maintain accurate and timely documentation of payer interactions, policy milestones, commitments, evidence requests, and follow-up actions in approved company systems.
Manage regional payer-relations projects, external consultants, budgets, and deliverables as assigned; ensure work is completed within approved scope and compliance requirements.
Mentor regional Market Access colleagues and contribute to consistent payerengagement standards, tools, training, and best practices across the organization.
Carry out all duties in accordance with company policies and procedures and applicable laws and regulations governing interactions with healthcare professionals, payers, and government entities.
QUALIFICATIONS EDUCATION REQUIREMENTS
Bachelor’s degree in health policy, healthcare administration, business, life sciences, health economics, public health, or a related field required; advanced degree preferred.
EXPERIENCE REQUIREMENTS
Minimum of 8 years of progressive experience in payer relations, market access, reimbursement, health policy, managed care, medical affairs, health economics, or a related healthcare field, including leadership of payer-facing initiatives.
Demonstrated experience engaging public and commercial payer stakeholders, including medical directors, policy teams, reimbursement leaders, or technology-assessment functions.
Demonstrated experience influencing or supporting coverage-policy development, policy reconsideration, evidence review, or payer medical-policy processes.
Strong working knowledge of Medicare and commercial payer policy infrastructure, medical policy development, coding, coverage, payment methodologies, claims processes, and provider reimbursement.
Experience in medical devices, ophthalmology, specialty physician-administered procedures, diagnostics, or another coverage-policy-intensive healthcare category preferred.
Experience translating clinical and economic evidence into payer-relevant materials, presentations, and strategic recommendations.
Experience leading cross-functional projects with Sales, Medical Affairs, Clinical, Regulatory, Legal, Compliance, Government Affairs, and Marketing partners.
Executive presence and credibility with payer medical, policy, and reimbursement decisionmakers.
Excellent written, verbal, presentation, negotiation, and relationship-management skills.
Ability to evaluate coverage policies and complex clinical, coding, claims, and reimbursement information and convert findings into practical action plans.
Strong strategic judgment, accountability, organization, and ability to operate independently in a field-based leadership role.
Ability to manage competing priorities, navigate ambiguity, and escalate material risks or decisions promptly.
Commitment to accurate, evidence-based, non-promotional, and compliant payer engagement.
Proficiency with Microsoft Office, CRM platforms, policy-tracking resources, and virtual meeting tools.
KEY MEASURES OF SUCCESS
Execution of prioritized regional payer engagement plans and completion of agreed payer follow-up actions.
Quality, accuracy, and strategic relevance of coverage-policy submissions, payer materials, account plans, and executive updates.
Progress toward clearer and more favorable TearCare coverage policies, criteria, and reimbursement pathways within prioritized regional payer accounts.
Timely identification and communication of policy changes, access barriers, evidence requests, risks, and opportunities.
Effective cross-functional coordination and compliant documentation of payer engagements and commitments.