Healthcare Market Access Counsel

Overview

This role serves as a senior legal advisor to the organization’s Market Access, Reimbursement, and Commercial teams, providing strategic counsel on complex healthcare, payer, reimbursement, and coverage matters. The position leads legal strategy supporting payer contracting and market access initiatives, using independent judgment to navigate evolving regulatory requirements, reimbursement frameworks, and business priorities.

The role partners closely with senior business leaders and cross-functional stakeholders to shape payer and reimbursement strategies, identify and mitigate legal and business risk, and develop practical solutions that advance patient access to the organization’s innovative diagnostic solutions. Success requires deep healthcare legal expertise, strong business acumen, and the ability to influence decisions across functions.

Responsibilities

• Lead legal strategy and provide senior-level counsel on payer contracting, reimbursement, coverage, and broader market access matters, balancing legal risk with commercial and patient-access objectives.
• Independently lead the review, drafting, and negotiation of complex and strategically significant agreements with private payors, including commercial insurers and managed care organizations.
• Serve as a strategic legal advisor to Market Access and senior business leaders, providing proactive counsel on payer strategy, reimbursement frameworks, coverage initiatives, and emerging market access opportunities and risks.
• Shape the organization’s legal approach to reimbursement and payer strategy by translating complex legal and regulatory requirements into practical business recommendations.
• Lead legal support for reimbursement and appeals strategies, partnering with Market Access, Reimbursement, Commercial, and other stakeholders to develop approaches to complex payer and coverage challenges.
• Advise on compliance with applicable federal and state healthcare laws, regulations, and guidance affecting billing, coding, reimbursement, payer contracting, and coverage.
• Evaluate complex payer policies, coverage determinations, reimbursement requirements, and contractual provisions; identify material legal, regulatory, and business risks and recommend appropriate strategies.
• Provide clear, pragmatic legal guidance that enables business objectives while appropriately managing organizational risk.
• Develop and implement legal frameworks, playbooks, contracting positions, templates, and scalable processes to improve consistency, efficiency, and risk management across payer contracting and reimbursement activities.
• Establish and deliver guidance and training for business leaders and internal stakeholders on payer contracting, reimbursement requirements, healthcare regulatory developments, and evolving market access considerations.
• Monitor and anticipate changes in the healthcare legal and regulatory landscape affecting managed care, reimbursement, coverage, and diagnostics, including federal policies such as PAMA and defrayal obligations, and evolving state biomarker coverage legislation.
• Partner with Legal and Compliance leadership on complex or high-risk matters, providing recommendations, escalating issues appropriately, and maintaining ownership through resolution.
• Provide leadership and subject-matter expertise across the organization to strengthen organizational capabilities in healthcare, reimbursement, payer contracting, and market access.

Requirements

• Juris Doctor (JD) from an accredited law school and active bar membership in good standing.
• 5+ years of relevant legal experience, including healthcare law, market access, or payer contracting.
• Experience reviewing and negotiating contracts with private payors, health plans, or managed care organizations.
• Strong understanding of U.S. healthcare reimbursement and coding systems, including commercial insurance and managed care structures, the MolDx program, AMA CPT codes, and the CLFS.
• Demonstrated experience supporting or advising on appeals strategies, coverage disputes, or reimbursement challenges.
• Ability to translate complex legal and regulatory issues into clear, actionable guidance for business partners.
• Strong collaboration and communication skills, with a track record of working effectively across cross-functional teams.
• High level of integrity, sound judgment, and attention to detail.

Preferred Qualifications

• Experience in diagnostics, life sciences, or laboratory services environments.
• Familiarity with payer policy development, utilization management, or claims adjudication processes.
• Experience working closely with market access, billing, revenue cycle, or reimbursement teams.
• Knowledge of federal and state healthcare regulations impacting diagnostics and coverage (e.g., Medicare, Medicaid, and commercial frameworks).
• Prior in-house experience in a growth-oriented healthcare or biotech organization or a commercial insurance company.
• Comfort navigating ambiguity and contributing to evolving processes in a dynamic, mission-driven environment.

Compensation & Benefits

Base pay range (depending on location):

• San Diego office: $160,000 - $206,700
• South San Francisco office: $167,000 - $216,500
• Remote: $152,000 - $196,000

Total compensation may include additional discretionary bonuses/incentives and restricted stock units. Final salary offered will depend on factors that may include years of experience, skillset, geographic location, industry, and education.

Location

• Onsite, hybrid, or remote work arrangements.
• San Diego office
• South San Francisco office
• Remote (within the applicable range provided for REMOTE candidates)