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Palo Alto, California, United States
Hybrid
As DELFI's dedicated Market Access & Reimbursement leader, you will own and build the U.S. access strategy for DELFI's product lines end to end. You will translate DELFI's clinical and health-economic evidence into coding, coverage, and payment strategy that put our early cancer detection products into patient care. This is a hands-on, player-coach role in which you will set strategy and execute it by prioritizing your engagements across working directly with CMS/Medicare, and/or MACs, and priority regional, integrated, and federal payers. Deep, current CMS/Medicare expertise is the center of gravity for this role. Over time, you will build out the function and the team beneath it.
This role operates within DELFI’s compliance framework separating non-promotional scientific exchange from commercial/reimbursement activity; external stakeholder engagement is coordinated with Legal/Compliance.
Own and execute DELFI's U.S. market access and reimbursement strategy across product lines, from coding and coverage through payment.
Serve as DELFI's subject-matter expert on CMS/Medicare, including Medicare Administrative Contractors, LCD/NCD processes, MolDX, and the ADLT, gapfill, and crosswalk pricing pathways relevant to novel diagnostics.
Develop and drive coverage strategies with priority payers, including Medicare, regional and integrated payers, and the VA.
Build formal strategic reimbursement plans for new product launches, including evaluation of coding, coverage, and payment options and innovative alternative payment models.
Partner cross-functionally with Medical Affairs, Clinical, Commercial, Regulatory, and Health Economics to align evidence generation with payer requirements and minimize utilization-management restrictions.
Partner with Legal/Compliance to ensure all engagement with payers, professional societies and KOLs complies with applicable law and industry codes, maintaining a clear distinction between non-promotional scientific exchange and commercial/reimbursement activity.
Identify health-economic evidence gaps and translate payer evidence needs into cross-functional study and dossier requirements.
Engage external stakeholders, including payers, health technology assessment bodies, professional societies, and KOLs, to shape favorable coverage policy in coordination with Commercial leadership on downstream adoption and utilization.
Establish the foundational tools, processes, and consultant and advisor network for a scalable market access function, and build the team as the function grows.
Required
Bachelor's degree with 12+ years (Director) or 15+ years (Senior Director), or Master's or advanced degree with 10+ or 12+ years of market access and reimbursement experience in diagnostics, medical devices, or pharma. Level will be set at offer based on depth of experience.
Deep, current expertise in CMS/Medicare, including coverage and payment pathways, Medicare Administrative Contractors, LCD/NCD processes, MolDX, and diagnostic-specific pricing mechanisms such as ADLT, gapfill, and crosswalk.
Demonstrated track record securing coverage and payment with CMS and U.S. commercial payers, ideally including regional, integrated, and VA or federal payers.
Expertise in coding classification systems (CPT, HCPCS, ICD-10) and payer policies governing billing and compliance.
Proven ability to build strategy and execute hands-on as a sole functional owner, with the resourcefulness to operate without a team initially.
Excellent communication, presentation, and influencing skills, with a demonstrated ability to reconcile multiple stakeholder views and negotiate matters of significance with senior internal and external leaders.
Preferred
Experience in molecular diagnostics, genomics, or multi-marker 'omic assays, or in early cancer detection.
Experience building or scaling a market access function from an early stage.
Direct experience with health technology assessment bodies and professional-society guideline strategy.
An advanced degree in public health, public policy, health economics, political science, or business.
