Description
PURPOSE OF JOB
The Payor Relations Director will lead all efforts to drive reimbursement coverage and policy, payor engagement, and coverage expansion for a portfolio of innovative ophthalmic medical devices and technologies. This individual will be responsible for cultivating strategic relationships with commercial and government payors, especially medical directors, and will play a pivotal role in ensuring broad and sustainable patient access.
The Payor Relations Director will also collaborate with Marketing, Medical Affairs, R&D, and Clinical teams to ensure market access and competitive advantage of Sight Sciences products, by developing and executing strategies that integrate health economics, outcomes research and market access solutions across all stages of the product lifecycle
MAJOR DUTIES AND RESPONSIBILITIES
Develop and execute payor strategy to achieve positive coverage, coding, and reimbursement for ophthalmic devices, with a focus on both new and existing technologies.
Build and maintain trusted relationships with key decision-makers at health plans-including Chief Medical Officers, Medical Directors, and Policy Teams-to influence clinical policy and coverage decisions.
Lead direct engagements with payor medical directors, providing clinical, economic, and outcomes-based evidence that supports the value of ophthalmic interventions.
Collaborate closely with Clinical, HEOR, and Medical Affairs teams to develop and present compelling clinical dossiers, value propositions, and real-world evidence tailored to ophthalmology payors.
Support coding initiatives including CPT and HCPCS applications, working with professional societies and coding consultants as needed.
Monitor and interpret changes in payor policies, CMS coverage decisions, and ophthalmology-specific reimbursement trends that impact product access.
Partner with field reimbursement and sales teams to troubleshoot local access barriers and identify opportunities for payor advocacy.
Contribute to pricing strategy and launch planning by delivering payor insights and forecasting reimbursement uptake across segments.
Act as the voice of the payor within cross-functional planning, ensuring access considerations are integrated into business decisions.
QUALIFICATIONS
- EDUCATION REQUIREMENTS
- Bachelor's degree in a HEMA related discipline in health economics, outcomes research or healthcare related field or equivalent experience required.
EXPERIENCE REQUIREMENTS
8+ years of progressive experience in payor relations, market access, or reimbursement in the medical device or biopharma industry; at least 3+ years focused on ophthalmology or a related specialty.
Demonstrated success in negotiating with and influencing payor medical directors, particularly for specialty medical technologies.
Deep understanding of reimbursement processes including coding (CPT, HCPCS), coverage policies, and payment models in ophthalmology.
Experience working with Medicare (including MACs), Medicaid, and commercial payors on policy development and coverage determinations.
Excellent communication, negotiation, and presentation skills, with the ability to translate clinical and economic data into actionable payor insights.
Leadership experience is a big plus.
OTHER QUALIFICATIONS
Direct experience launching ophthalmic devices requiring new coverage pathways or complex access environments (e.g., retinal implants, surgical devices, diagnostics).
Established relationships with ophthalmic societies, coding experts, and payor influencers.
Familiarity with site-of-service payment differences and ASC/HOPD reimbursement dynamics in ophthalmology.
Strong understanding of the US reimbursement systems and market access trends.
Ability to communicate clearly and concisely to large audiences; detail-oriented, self-motivated and ability to work independently.
Ability to take evidence and other complex data and package it into easy-to-understand deliverables that can support commercial use.
Intellectual interest in keeping abreast of market access and reimbursement trends.
Solution-oriented, with the ability to offer creative options for problem solving.
Work closely with multiple cross-functional partners, including Sales, Strategic Marketing, Business Development, Medical Affairs, Clinical Research, US Commercial Marketing, Regulatory Affairs, R&D and Legal.
PHYSICAL DEMANDS
Sitting for extended periods of time, the employee regularly works in an office environment as well as meetings at physician offices or hospitals and payers as required.
Position interacts periodically with external customers such as physician providers and economic decision makers in the hospital and payers to assist with describing the value proposition of the company's technology. Position will interact with the US government payer (CMS), commercial payers and medical societies on reimbursement and market access topics related to use of company technology.
TRAVEL REQUIREMENTS
The percentage of expected travel for domestic, international, or both is estimated to be 20%.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
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Sight Sciences
Jul 08, 2025