Director, Commercial Reimbursement - Remote, USA

Calyxo, Inc. is a medical device company headquartered in Pleasanton, California, USA. The company was founded in 2016 to address the profound need for improved kidney stone treatment. Kidney stone disease is a common, painful condition that consumes vast amounts of healthcare resources each year. Our team is led by executives and investors with a proven track record of commercializing paradigm-shifting devices to meet unmet needs within urology.Are you ready to change the future of kidney stone treatment? We are seeking high achievers who want to be part of a dynamic team working in a fun, diverse atmosphere.Summary: The Director of Commercial Reimbursement is responsible for leading Calyxo’s commercial health plan reimbursement strategy and execution. This role has accountability for commercial payer coverage strategy, payer negotiations, and reimbursement operations, including management of the Market Access Manager team. This position also provides leadership and coaching to the Market Access Manager team, ensuring clear priorities, strong execution, and ongoing development of capabilities across the function.The position requires a balance of strategic payer engagement and oversight of reimbursement execution, with direct involvement in high‑impact or escalated coverage or payment challenges, policy appeals, claim denials, and provider support requiring senior‑level payer engagement or cross‑functional coordination. The Director will act as a subject‑matter expert on commercial coverage and payment and serve as a key partner to Commercial, Medical, and Sales leadership.In This Role, You Will:Commercial Payer Strategy and Policy ManagementDevelop and execute commercial reimbursement strategies aligned with company objectives and growth plans.Lead engagement with national, regional, and local commercial health plans, including medical directors and policy teams.Drive efforts to influence, establish, or revise commercial payer medical policies, including:Challenging non-coverage determinations, including “Investigational and Experimental” designationsAddressing restrictive utilization criteriaSupporting appropriate coverage pathwaysLead escalation of payer policy disputes and coverage barriers that cannot be resolved through standard operational channels.Drive support for efforts to ensure appropriate reimbursement in cases of commercial payer underpaymentProvide leadership on payer positioning, value messaging, and reimbursement implications of payer decisions.Payer Negotiations and External EngagementServe as the primary commercial reimbursement contact for payer negotiations and senior level escalations, including direct engagement with medical directors and payer leadership.Coordinate and support peer‑to‑peer, appeal, and reconsideration efforts involving clinical and provider stakeholders.Apply in‑depth understanding of commercial payer processes, timelines, and decision-making frameworks.Physician and Provider EngagementSupport the identification and development of physician champions to reinforce payer engagement activities.Partner with providers to address reimbursement issues across outpatient sites of service.Ensure reimbursement strategies align with real-world site‑of‑care dynamics and provider operational needs.Reimbursement Operations and Team LeadershipProvide direct people management and leadership for the Market Access Manager team.Establish and maintain standardized processes, tools, and best practices to ensure consistent field execution.Set performance expectations, coach team members, and support ongoing development.Serve as the escalation point for complex, high-risk, or precedent setting reimbursement issues with material access, revenue, or policy implications, including direct payer engagement when required.Cross-Functional CollaborationCollaborate with Commercial, Sales, Medical Affairs, Legal, Compliance, and Finance teams to ensure integrated reimbursement planning and compliant execution.Provide reimbursement guidance to support commercial planning, launch readiness, and field enablement.Represent commercial reimbursement perspectives in cross functional forums and leadership discussions.Reporting and Performance ManagementDevelop metrics and reporting to assess reimbursement performance and identify areas of risk or opportunity.Use payer policy data and claims insights to inform strategic prioritization, escalation decisions, and payer engagement strategies, including identification of issues requiring senior level intervention.Drive continuous improvement in reimbursement strategy and operational effectiveness using data informed insights.Who You Will Report To:Sr. Director, Market AccessRequirements:Bachelor’s degree required; advanced degree preferred (health policy, health services administration, public health).Minimum 8 years of progressively responsible experience, including accountability consistent with a Senior Manager or Director level role, in reimbursement, marke