Director, Commercial Reimbursement

Calyxo, Inc. is a medical device company headquartered in Pleasanton, California, USA. The company was founded in 2016 to address the profound need for improved kidney stone treatment. Kidney stone disease is a common, painful condition that consumes vast amounts of healthcare resources each year. Our team is led by executives and investors with a proven track record of commercializing paradigm-shifting devices to meet unmet needs within urology.

Are you ready to change the future of kidney stone treatment? We are seeking high achievers who want to be part of a dynamic team working in a fun, diverse atmosphere.

Summary:

The Director of Commercial Reimbursement is responsible for leading Calyxo’s commercial health plan reimbursement strategy and execution. This role has accountability for commercial payer coverage strategy, payer negotiations, and reimbursement operations, including management of the Market Access Manager team. This position also provides leadership and coaching to the Market Access Manager team, ensuring clear priorities, strong execution, and ongoing development of capabilities across the function.

The position requires a balance of strategic payer engagement and oversight of reimbursement execution, with direct involvement in high‑impact or escalated coverage or payment challenges, policy appeals, claim denials, and provider support requiring senior‑level payer engagement or cross‑functional coordination. The Director will act as a subject‑matter expert on commercial coverage and payment and serve as a key partner to Commercial, Medical, and Sales leadership.

In This Role, You Will:

Commercial Payer Strategy and Policy Management

• Develop and execute commercial reimbursement strategies aligned with company objectives and growth plans.
• Lead engagement with national, regional, and local commercial health plans, including medical directors and policy teams.
• Drive efforts to influence, establish, or revise commercial payer medical policies, including:
  • Challenging non-coverage determinations, including “Investigational and Experimental” designations
  • Addressing restrictive utilization criteria
  • Supporting appropriate coverage pathways
• Lead escalation of payer policy disputes and coverage barriers that cannot be resolved through standard operational channels.
• Drive support for efforts to ensure appropriate reimbursement in cases of commercial payer underpayment
• Provide leadership on payer positioning, value messaging, and reimbursement implications of payer decisions.

Payer Negotiations and External Engagement