Manager, Market Access Analytics & Payer Strategy

Koya Medical is a growth-stage healthcare company developing breakthrough technologies for venous and lymphatic disease. Our mission is to improve patient outcomes and empower self-care through innovative, people-centric solutions. We are seeking analytically rigorous and strategically minded professionals who want to help transform market access and reimbursement performance in a fast-paced, mission-driven environment.

About Koya Medical Koya Medical, a privately held company founded in 2018, is a transformative healthcare company developing breakthrough treatments for venous diseases and lymphedema to enable joint contractions, patient mobility, and personalized care that is unavailable with traditional compression therapy. Koya is always looking for curious and passionate individuals who want to join a fast-paced team for a career in transforming venous and lymphatic care through innovative people-centric technologies that improve lives and empower self-care. Koya values integrity, humility, hard-work, camaraderie, and fun. We offer a base bonus compensation package, and a competitive benefits program.

Description Position Summary The Manager, Market Access Analytics & Payer Strategy will play a critical role in shaping payer access, reimbursement performance, and revenue realization across Medicare, Medicare Advantage, Commercial, and Medicaid segments.

This individual will generate payer intelligence, revenue cycle insight, and commercial access analytics to inform contracting strategy, sales deployment, evidence development priorities, and operational performance.

This role reports to the Director, Reimbursement Operations and partners closely with Market Access, Commercial Leadership, Finance, Sales Operations, and Executive Leadership.

Key Responsibilities Payer Coverage Intelligence & Access Strategy

• 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

Revenue Realization & Reimbursement Performance Analytics

• 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

Commercial Funnel & Market Deployment Analytics

• 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

Contracting Economics & Financial Modeling

• 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

Executive Insights & Decision Support

• 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

Required Qualifications Education & Experience

• 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
• Experience in Durable Medical Equipment, medical device reimbursement environments strongly preferred

Domain Expertise

• 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

Analytical & Technical Skills

• 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
• Experience working with CRM, reimbursement workflow systems, or claims datasets preferred

Leadership & Collaboration

• 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

Key Success Metrics (First 12–18 Months)

• Improvement in net revenue realization per shipped unit
• Increased prior authorization approval rates and appeal overturn yield
• Reduction in reimbursement cycle time and revenue leakage
• Identification and execution of payer access expansion opportunities
• Development of actionable payer intelligence frameworks used by Market

Access and Commercial leadership

Tools & Environment

• Google Workspace, Microsoft Office
• Business Intelligence platforms (Power BI / Tableau)
• Salesforce CRM or similar commercial systems
• Remote work environment with periodic travel as needed

Salary

$115,000 – $125,000 per year