Sr. Director, Reimbursement & Patient Access

Rayner is a leading developer and manufacturer of ophthalmic implants and pharmaceuticals with global headquarters in Worthing, UK. We specialize in the design and manufacture of intraocular lenses (IOLs) and related products, such as OVDs and pharmaceuticals used in cataract and refractive surgery. Since the manufacture of the world’s first IOL by Rayner in 1949, we have continuously pioneered IOL design with a goal of improving vision and restoring sight worldwide. The first ever FDA- approved IOL was a Rayner lens. Today, over 26 million IOLs are implanted around the world every year, and it is globally the most performed elective surgical procedure. Our mission is simple: to deliver excellent visual outcomes for patients and surgeons.

In June 2021 Rayner was acquired by CVC, an international Private Equity business with substantial funds under management. CVC has already shown itself to be an excellent partner to Rayner and has demonstrated its commitment to grow the business internationally. With CVC as our partner, we have the resources to make further investments in ophthalmology.

Since Rayner was founded in 1910, we have established a reputation for innovation and product excellence. Rayner has over 400 employees in the UK, Germany, Austria, Switzerland, Spain, Portugal, Italy, US, Canada, Malaysia and India. Today, we have offices in New York and Memphis. Rayner Surgical Inc and Omeros Corporation have announced the signing of an agreement to transfer Omeros’s ophthalmology assets, including OMIDRIA and the teams to support the product to Rayner. Rayner will open an office in Seattle and the OMIDRIA team will be a big part of our growth.

The Sr. Director, Reimbursement & Patient Access will be responsible for the development and implementation of the overall site of care reimbursement and patient access strategy for the Rayner portfolio.  This individual will lead the field-based Reimbursement Managers team.  This individual will work with cross-functional partners (i.e., Marketing, Sales, Advocacy, Account Management, Patient Services, and Medical) to deploy solutions that drive local business opportunities, ensuring team alignment in overall execution of strategy. An expert in reimbursement and access (i.e. buy and bill processes, billing and coding, medical policy), this individual will be a key influencer to the overall market access strategy and payer value propositions across the portfolio. 

Ambition: We play to win.

Focus: We put patients first. 

Integrity: We keep our promises.

Openness: We are passionate about new ideas.

Respect: We support each other.

Your key responsibilities will be:

• Attract, hire, and develop a diverse organization
• Continuously coach and develop advanced leadership and patient access and reimbursement
• Create a high-performance culture with emphasis on accountability, drive for/recognition of results, collaboration, ethical behavior, and a culture of accountability for conducting business with integrity within legal guidelines 
• Translate market insights to influence and/or shape reimbursement strategy
• Partner with Market Access Leadership Team to provide input on payer value proposition and development of reimbursement acumen relative to the total account strategy; coach a team to effectively respond to payer marketplace changes 
• Implement a process for best practice sharing across the teams to maximize efforts in reimbursement
• Lead and provide input into appropriate business strategies, plans, goals and tactics including expertise in reimbursement issues encompassing billing & reimbursement guidelines by payor and site of care, understanding guidelines, DRGs, and pricing structures
• Support product launch teams with billing and coding needs, including vendor management when appropriate
• Set measurable and consistent key performance indicators, holding team accountable and leading to achieve/exceed goals  
• Lead relationship with contract stem-cell transplant Reimbursement team vendor ensuring accountability with all SOPs, KPIs, compliance guidelines, and performance goals
• Develop processes to drive clear communication with sales colleagues, ensuring clarity with reimbursement issues and trouble-shooting opportunities in support of pull through efforts
• Ensure team operates consistently with Healthcare Compliance guidelines
• Incorporate knowledge of dynamic and complex marketplace and business trends to deliver maximum access
• Monitor National Commercial, Medicare, and Medicaid communications on coverage, coding, and payment policy and potential policy changes

Education, Experience, Skills, & Knowledge Required:

• Bachelor’s degree in business, marketing, or life sciences
•  10+ years of biotechnology or pharmaceutical industry commercial experience including management experience
•  Experience with “start-up” bio pharma company and/or at least one product launch
•  Experience negotiating contracts and agreements
•  Experience and familiarity with ophthalmology,  and/or device products desirable
•  Experience and deep understanding of healthcare and account management, navigating complex accounts critical for success (working with health systems, IDNs, PEs etc.)
•  Exceptional business acumen and problem-solving skills; is aware of how different reimbursement strategies and tactics work in the marketplace
•  Advanced understanding of compliance and regulatory requirements
•  Demonstrated knowledge of payer decision-making, coverage, coding (i.e. J code), ASP, billing and patient access to specialty biologics, CMS, Medicare, Medicare Advantage, bundle vs. separate reimbursement, and pass through status 
•  Demonstrated ability to recognize and interpret business issues/opportunities and make sound business judgments regarding solutions
•  Outstanding collaboration and networking capabilities
•  Demonstrated success leading teams through collaboration with other members within and across sales, marketing, market access, medical, and other groups to improve overall effectiveness
•  Good interpersonal and communication skills (both verbal and written), planning and organizational skills
•  Proficient with MS Office and basic technology tools

Behavioral Competencies Required:

•  Ability to build strategic relationships and problem solve with key internal and external customers
•  Ability to influence and negotiate with business partners, management and senior level leaders regarding matters of significance to the organization
•  Strong team player with demonstrated ability to build and maintain positive relationships with management, peers, and subordinates
•  Adept at creating and communicating a clear vision among cross-functional team members effectively aligning resources to achieve functional area goals
•  Ability to make decisions that balance a variety of factors to achieve optimal outcomes
•  Strong project ownership and sense of urgency to deliver best results on time
•  Proven track record of consistently meeting or exceeding results and/or other quantitative targets, as well as qualitative goals
•  Demonstrates confidence
•  Integrity and personal credibility 

Other Requirements:

• Ability to travel up to 50% of the time