Sr Dir Patient Access & Advocacy

The Senior Director, Patient Access & Advocacy leads the strategy and operations of the Patient Access Program, with responsibility for how patients and treatment sites navigate coverage, prior authorization, reimbursement, and payer escalation. The role combines hands-on knowledge of complex access cases with the leadership needed to build a program that is consistent, scalable, and responsive to a changing reimbursement environment.

This position serves as a senior internal resource on patient access and payer issues. It identifies patterns across individual cases, brings forward coverage and reimbursement barriers that may have broader business impact, and works with Market Access, HEMA, Medical Affairs, Clinical, Legal, Policy, Regulatory, Sales, Marketing, and Commercial Operations to determine the right response.

The Senior Director also owns the continued development of the Patient Access team, workflows, technology, reporting, and quality standards, with a focus on practical execution, sound judgment, and a strong patient experience.

Patient Access Program Leadership

• Set the direction for the Patient Access Program and lead its day-to-day operation and continued development.
• Build and refine workflows for benefit review, predetermination, prior authorization, appeals, external review, and other access pathways as program needs evolve.
• Provide direction on complex or high-priority cases and determine when a payer issue should be escalated beyond the individual case.
• Identify gaps in process, staffing, technology, or training and put practical solutions in place before they affect program quality or patient experience.
• Create operating standards that support consistent work across the team without adding unnecessary steps or administrative burden.
• Keep senior leadership informed of meaningful access trends, emerging barriers, program needs, and areas requiring cross-functional action.

Payer Access & Reimbursement Strategy

• Lead patient-level reimbursement strategy across commercial insurance and Medicare Advantage plans.
• Guide payer submissions and escalations involving medical necessity, investigational or experimental determinations, coverage limitations, and other complex reimbursement issues.
• Review payer policies, coverage criteria, denial language, coding requirements, and reimbursement practices to determine the strongest path forward for a case or recurring issue.
• Develop and guide medical-necessity and appeal strategies using the patient record, clinical evidence, published literature, guideline language, coding information, Medicare/CMS policy, and applicable plan criteria.
• Track recurring approval, denial, and appeal patterns and bring material payer trends to Market Access, HEMA, Medical Affairs, Policy, Legal, and Commercial leadership.
• Translate payer and regulatory changes into clear guidance that treatment sites and internal teams can use in practice.

Patient Advocacy & Access Escalation

• Keep the patient impact visible when access processes, policies, and escalation pathways are developed or changed.
• Help patients and treatment sites understand the administrative steps required to pursue coverage and what information may be needed from them.
• Identify cases that need additional review or escalation and make sure they reach the appropriate internal or external pathway.
• Work with clinical and advocacy stakeholders to improve patient-facing access education and resources.
• Maintain clear boundaries between reimbursement support and clinical decision-making while still advocating for a fair and complete payer review.

Operations, Analytics & Technology

• Define the metrics that matter for the Patient Access Program and use them to understand workload, quality, turnaround time, payer behavior, and program performance.
• Build reporting that gives leadership a useful view of approvals, denials, appeals, external reviews, case volume, and emerging access issues.
• Use program data to spot early signs of payer changes, workflow problems, capacity concerns, or documentation gaps.
• Provide operational leadership for Patient Access CRM and technology development, including workflow design, case tracking, status reporting, data requirements, and reporting needs.
• Maintain the accuracy and integrity of Patient Access data so reporting can be relied on for business decisions.
• Evaluate process and technology improvements based on whether they make the work clearer, faster, more consistent, or easier to scale.

Cross-Functional & Field Partnership

• Work closely with Market Access, HEMA, Medical Affairs, Clinical, Legal, Policy, Regulatory, Sales, Marketing, and Commercial Operations on access issues that cross functional lines.
• Give internal teams a practical view of how payer policies and reimbursement requirements are affecting patients, physicians, and treatment sites in the field.
• Partner with field teams to identify account-specific and market-specific access barriers and determine what support or escalation is appropriate.
• Support provider and treatment-site education on reimbursement pathways, documentation expectations, and Patient Access Program processes.
• Maintain strong working relationships with physicians, reimbursement teams, treatment sites, payer-facing stakeholders, and other partners involved in access.
• Present patient access and reimbursement information internally and externally when training, education, or leadership visibility is needed.

Team Leadership & Development

• Directly manage Patient Access personnel, with responsibility for hiring, onboarding, training, coaching, performance management, and professional development.
• Set clear expectations for judgment, quality, responsiveness, documentation, and accountability, and make sure team members understand what good performance looks like in practice.
• Develop and maintain role-specific onboarding, training, and competency standards covering payer processes, Patient Access Program workflows, documentation requirements, privacy and compliance expectations, and escalation protocols.
• Provide ongoing training and case-based coaching so team members can handle increasingly complex payer and patient access issues with sound judgment and appropriate independence.
• Monitor individual and team workload, case quality, productivity, and program capacity, and address staffing, resource, or skill gaps before they affect service or quality.
• Recruit and retain strong Patient Access talent, provide regular feedback and performance evaluations, recognize development opportunities, and address performance concerns directly when expectations are not being met.

Compliance & Program Governance

• Ensure Patient Access activities follow company policy, privacy requirements, reimbursement compliance standards, and applicable regulatory expectations.
• Maintain appropriate controls around patient consent and authorization, protected health information, payer documentation, and clinical records used in access work.
• Work with Legal, Compliance, Regulatory, and other stakeholders when a new process, unusual payer situation, or program change raises a compliance or policy question.
• Maintain quality-review processes that support accurate, complete, and defensible payer submissions and communications.
• Address compliance or process concerns promptly and adjust workflows when needed.

QUALIFICATIONS

EDUCATION REQUIREMENTS

• Bachelor’s degree or an equivalent combination of education and relevant professional experience.
• Significant progressive experience in patient access, reimbursement, utilization management, payer operations, market access, or a related healthcare function.
• Demonstrated experience building, leading, or materially expanding a patient access or reimbursement program.
• Leadership experience directly managing personnel, developing staff, and creating operating processes that can scale.
• Medical device, biotechnology, pharmaceutical, or other complex healthcare experience strongly preferred.
• Experience with therapies or procedures that have evolving coverage, coding, reimbursement, or medical-necessity requirements is strongly preferred.

EXPERIENCE REQUIREMENTS

Strong command of the commercial insurance landscape and the reimbursement processes that affect patient access.

• Working knowledge of Medicare and Medicare Advantage, including CMS coverage, coding, and payment principles.
• Direct experience with predetermination, prior authorization, utilization management, medical-necessity review, appeals, and external or independent review.
• Ability to read payer medical policies and coverage criteria and apply them to real patient and provider situations.
• Ability to review clinical research, published literature, and guidelines and understand how the evidence supports reimbursement and medical-necessity strategy.
• Strong understanding of how coding, coverage, reimbursement, clinical documentation, and payer decision-making fit together.
• Experience with Salesforce or comparable CRM/case-management platforms and the ability to help shape workflow and reporting requirements.
• Strong business writing, presentation, analytical, and communication skills, including the ability to explain complex reimbursement issues clearly to different audiences.
• • Proficiency with Microsoft Word, Excel, PowerPoint, Outlook, and standard business technology

OTHER QUALIFICATIONS

• This role requires someone who can move comfortably between strategy and execution. The Senior Director should be able to work through the details of a difficult payer case, recognize when the issue is bigger than one patient, and then bring the right people together to address it. Strong judgment, credibility, and the ability to influence across functions are more important than rigid process ownership.
• Makes sound decisions when payer policy or reimbursement requirements are unclear or changing.
• Communicates directly and clearly with executives, field teams, providers, patients, and external stakeholders.
• Challenges processes when they are not working and offers a workable alternative.
• Builds strong relationships across functions without needing direct authority over every stakeholder.
• Balances patient needs, provider realities, business priorities, and compliance requirements.
• Develops people who can think independently and handle increasingly complex work with good judgment.

NOTE

This is not necessarily an exhaustive list of all responsibilities, skills, duties, requirements, efforts, or working conditions associated with the job. While this is intended to be an accurate reflection of the current job, management reserves the right to revise the job or to require that other or different tasks be performed when circumstances change (e.g., emergencies, changes in personnel, variation in workload, rush jobs, or technological developments).