Manager, Market Access Analytics & Payer Strategy

Koya Medical is a growth-stage healthcare company developing breakthrough technologies for venous and lymphatic disease. The Manager, Market Access Analytics & Payer Strategy will play a critical role in shaping payer access and reimbursement performance across various segments, generating insights to inform contracting strategy and operational performance.

Responsibilities:

• Develop and maintain structured payer policy intelligence across MACs, Medicare Advantage plans, and commercial payers
• Quantify impact of coverage criteria, utilization management, and documentation requirements on patient access and revenue realization
• Build predictive models to estimate coverage pull-through probability and access velocity by payer and geography
• Monitor policy revisions, enforcement trends, and adjudication variability and translate insights into actionable market access strategies
• Support evidence strategy by identifying coverage barriers and prioritizing data generation opportunities
• Analyze prior authorization, denial, appeal, and claims outcomes to identify root causes of revenue leakage
• Develop denial taxonomy and overturn yield analytics to optimize appeals strategy and operational resource allocation
• Model net revenue realization by payer, plan type, and contract structure
• Evaluate underpayments, payment variance trends, and resubmission success patterns
• Provide insight into time-to-cash drivers and reimbursement cycle performance
• Partner with Commercial Analytics and Sales Operations to quantify patient funnel conversion rates from referral through reimbursement
• Develop territory-level payer friction maps to inform targeting and sales resource deployment
• Analyze payer mix profitability and contribution margins across segments and channels
• Quantify pull-through impact of payer access on sales productivity and growth opportunities
• Develop financial models to support payer negotiations including pricing strategy, margin sensitivity, and volume impact scenarios
• Forecast revenue implications of value-based arrangements, policy shifts, and contracting decisions
• Support Finance and Market Access leadership with scenario modeling and long-range planning inputs
• Translate complex payer and reimbursement analytics into clear executive-level recommendations
• Build dashboards and scorecards that track access velocity, revenue realization, denial performance, and payer mix dynamics
• Proactively identify strategic opportunities to expand coverage, optimize pricing, and improve reimbursement outcomes

Requirements:

• Bachelor's degree in Finance, Economics, Healthcare Administration, Data Analytics, or related field
• 5+ years of experience in healthcare reimbursement analytics, payer strategy, revenue cycle analytics, or market access analytics
• Deep understanding of payer environments including: Medicare Fee-for-Service and DME MAC adjudication dynamics, Medicare Advantage plan structures and utilization management, Commercial payer coverage policies and contracting frameworks, Medicaid and Managed Medicaid reimbursement considerations
• Familiarity with coding, documentation requirements, prior authorization pathways, and denial management best practices
• Advanced financial modeling and scenario analysis capabilities
• Strong data manipulation and visualization skills using Excel, Power BI, Tableau, or similar tools
• Ability to synthesize quantitative and qualitative insights into strategic recommendations
• Proven ability to influence cross-functional stakeholders and drive data-informed decision making
• Strong communication skills with the ability to present to senior leadership
• Demonstrated initiative, critical thinking, and ownership mindset
• Ability to operate effectively in a growth-stage, fast-changing environment
• Experience in Durable Medical Equipment, medical device reimbursement environments strongly preferred
• Experience working with CRM, reimbursement workflow systems, or claims datasets preferred