Senior, Director, Health Policy & Reimbursement

KEY RESPONSIBILITIES

• Monitor federal and state legislative, regulatory, coding, payment, and coverage developments affecting clinical laboratories, molecular diagnostics, genomics, rare disease, and precision medicine; convert changes into clear enterprise implications and action plans.
• Represent Baylor Genetics in health policy matters with trade associations, standards-setting organizations, public agencies, coalitions, payer policy forums, and other external stakeholders.
• Lead end-to-end coding strategy for new and existing products, including applications for new or revised CPT codes through the American Medical Association and coordination of ICD-10-CM code proposals through the Centers for Disease Control and Prevention and other appropriate federal processes.
• Develop evidence, utilization, clinical-workflow, and economic rationales required to support coding, valuation, coverage, and reimbursement submissions.
• Lead state health policy strategies that accelerate adoption and sustainable funding of rapid WGS for critically ill infants and children, including Medicaid, appropriations, coverage mandates, pilots, and implementation pathways.
• Partner with authorized Government Affairs resources, external coalitions, and registered lobbyists to educate and engage state legislatures and members of the U.S. Congress on Baylor Genetics priorities in accordance with Legal and Compliance requirements.
• Lead upstream pipeline reimbursement planning for new products, platform extensions, and tuck-in acquisitions, including coding, coverage, payment, evidence, channel, operational, and commercialization-readiness assessments.
• Integrate reimbursement and policy diligence into business-development evaluations, identifying access risks, evidence gaps, investment requirements, and post-close integration priorities.
• Guide responses to proposed federal and state rules, payer policies, fee schedules, laboratory payment reforms, and other public-comment opportunities.
• Build executive-ready policy briefs, scenario analyses, risk assessments, and recommendations for senior leadership and the Board, as appropriate.
• Partner with Revenue Cycle and Finance to assess payment adequacy, coding performance, denial patterns, fee-schedule changes, and financial impact.
• Maintain governance, documentation, and compliance controls for policy engagement, coding submissions, coalition activity, and external representation.

People Leadership Responsibilities

• Lead, coach, develop, and retain a team responsible for health policy, coding, reimbursement strategy, and government-affairs coordination.
• Establish measurable objectives, operating rhythms, decision rights, and accountability aligned to enterprise priorities.
• Conduct regular portfolio, policy, and pipeline reviews; remove barriers and ensure timely execution of critical submissions and advocacy initiatives.
• Develop succession plans and expand organizational capability in laboratory policy, coding, payment, and state-government engagement.
• Promote a culture of integrity, evidence-based advocacy, cross-functional partnership, and execution excellence.

Core Deliverables

• Annual federal and state health policy strategy with prioritized issues, stakeholders, risks, and action plans.
• CPT and ICD-10-CM coding roadmaps, applications, evidence packages, and milestone plans for priority products.
• State rWGS adoption strategy, including legislative, Medicaid, appropriations, coalition, and implementation pathways.
• Congressional and state policy engagement plans executed with authorized Government Affairs and Compliance partners.
• Pipeline and acquisition reimbursement-readiness assessments with clear go/no-go considerations and investment requirements.
• Executive dashboards covering policy developments, coding milestones, reimbursement risks, advocacy progress, and expected business impact.

Key Success Metrics

• Achievement of coding milestones and favorable outcomes for priority CPT and ICD-10-CM initiatives.
• Number and quality of state policies, Medicaid pathways, appropriations, or programs advancing rWGS adoption.
• Progress against federal and state policy priorities, including compliant engagement with members of Congress and legislative stakeholders.
• Pipeline products and tuck-in acquisitions entering commercialization with complete coding, coverage, payment, and evidence strategies.
• Timely identification and mitigation of material legislative, regulatory, coding, and reimbursement risks.
• Improvement in payment adequacy, coding clarity, reimbursement predictability, and access for Baylor Genetics products.
• Team performance, retention, succession readiness, and achievement of annual objectives.
• Quality, timeliness, and executive usefulness of policy intelligence, scenario planning, and recommendations.

QUALIFICATIONS

Required

• Bachelor’s degree in Health Policy, Public Health, Life Sciences, Business, Healthcare Administration, Health Economics, or a related field.
• 7+ years of leading teams in health policy and reimbursement
• 12+ years in progressive experience, combination with the following experience;

o8+ years of progressive experience in health policy, reimbursement, coding, government affairs, market access, or related healthcare leadership roles.

o8+ years of direct laboratory health policy and reimbursement experience, preferably in molecular diagnostics, genomics, or precision medicine.

• Demonstrated experience leading CPT coding strategy and familiarity with ICD-10-CM coordination and federal coding processes.
• Demonstrated success influencing state or federal health policy, reimbursement, Medicaid, or legislative initiatives through compliant advocacy and coalition engagement.
• Experience leading and developing teams responsible for policy, coding, reimbursement, or government affairs.
• Ability to interpret legislation, regulations, coding guidance, payment policy, and payer requirements and translate them into business strategy.
• Executive-level communication, deductive storytelling, negotiation, and cross-functional influence skills.
• Ability and willingness to travel approximately 40–50% domestically.

Preferred:

• MBA, MPH, MHA, JD, MS, PharmD, PhD, or equivalent advanced degree.
• Experience with rWGS, WGS, WES, NGS, rare disease, oncology genomics, reproductive genetics, or pediatric critical care.
• Experience with AMA CPT processes, CMS payment systems, state Medicaid programs, and CDC ICD-10-CM coordination processes.
• Established relationships with laboratory trade associations, patient-advocacy organizations, state policy coalitions, federal agencies, and legislative stakeholders.
• Experience supporting product pipeline strategy, licensing, mergers and acquisitions, or post-acquisition integration.
• Experience developing public-comment letters, legislative language, fiscal-impact analyses, or reimbursement evidence packages.

COMPETENCIES

✓ Enterprise Health Policy Leadership ✓ Laboratory Coding & Reimbursement

✓ Government Affairs & Advocacy ✓ State Policy Strategy

✓ Pipeline & Acquisition Planning ✓ Executive Presence & Influence

✓ Evidence-Based Communication ✓ Cross-Functional Collaboration

✓ People Leadership & Talent Development ✓ Compliance & Execution Excellence

ROLE IMPACT

This role shapes the policy, coding, and reimbursement environment required to accelerate rWGS adoption, support product innovation, enable strategic growth, and expand patient access to Baylor Genetics testing.

PHYSICAL DEMANDS AND WORK ENVIRONMENT

·Location: Remote

• Physical demands for the job (e.g., Must be able to lift 25 lbs, standing for prolonged periods of time, etc.)
• Work environment required for the job duties (e.g., Exposure to laboratory chemicals, etc.)

·Travel Requirements

• Special conditions (e.g. lab/clinical requirements if applicable)

·Approx 40% - 50% domestic Travel

EEO STATEMENT

Baylor Genetics is proud to be an equal opportunity employer committed to fostering an inclusive and diverse workplace. We welcome and encourage applicants from all backgrounds to apply. We do not discriminate on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, age, veteran status, disability, genetic information, pregnancy, childbirth, or any other status protected by applicable federal, state, or local law. If you need an accommodation during the application process, please contact our Human Resources team.

Originally posted on Himalayas