Coding Jobs in San Mateo, CA

Sr/Director Of Healthcare Economics And Market Access

Cytovale is a leading innovator in early sepsis detection, revolutionizing emergency care with its advanced IntelliSep technology. This system provides rapid, actionable insights into a patient's likelihood of having or developing sepsis through a quick 8-minute blood test. IntelliSep's unique capability to assess immune dysregulation enhances the triage and treatment of sepsis, promoting patient-centered care, operational efficiencies, and provider satisfaction. Cytovale is committed to the successful implementation, clinical adoption, and continual improvement of healthcare outcomes.

Position Overview: Cytovale is hiring a Sr/Director of Healthcare Economics and Market Access to own the IntelliSep ROI narrative and turn it into a repeatable, defensible tool that drives adoption and expansion across health systems. This role goes beyond a traditional health economics and market access (HEMA) function. In addition to the standard HEMA scope (coding, coverage, payer strategy, evidence generation support), this person will work directly with hospital finance, coding, and revenue cycle teams to communicate, find, and help capture value that IntelliSep enables, but that hospitals often leave on the table. This is a hybrid clinical economics and revenue cycle role.

Key Responsibilities:

• Build, maintain, and continuously refine the core IntelliSep economic model and value narrative, incorporating new clinical evidence, coding and reimbursement changes, and customer-specific data as they become available.
• Translate clinical outcomes data (length of stay, mortality, antibiotic timing, resource utilization) into financial terms that resonate with health system CFOs, CMOs, and CQOs.
• Maintain a set of modular ROI tools (calculators, one-pagers, board-ready decks) that can flex to a given system's payer mix, cost structure, and sepsis program KPIs.

Engage with Hospital System Executive Leadership

• Serve as Cytovale's primary voice on economic value in front of hospital system C-suite and finance leadership, including CFOs, VPs of revenue cycle, and quality/finance committees.
• Partner with sales and marketing to prepare and deliver executive-level business reviews and value-realization presentations at target accounts.
• Represent Cytovale's economic point of view at conferences, KOL events, and payer or health system forums as needed.

Identify and Pursue Revenue Cycle Opportunities with Customers

• Work directly with hospital coding, billing, and revenue cycle teams to identify sepsis-related coding and documentation gaps, including incomplete severity of illness capture, missed comorbidity/complication (CC/MCC) coding, and documentation gaps that affect DRG assignment.
• Help customers understand and contest inappropriate DRG downgrades and payer denials connected to sepsis diagnoses, providing supporting clinical and coding rationale where appropriate.
• Build repeatable playbooks and audit approaches that hospital partners can use on their own coding and billing data to find these opportunities systematically, not just once.
• Identify other value capture opportunities tied to IntelliSep adoption (e.g., quality measure performance, care pathway efficiency, downstream cost avoidance) and quantify them for customers.
• Coordinate with legal/compliance to ensure all revenue cycle guidance stays within appropriate bounds (Cytovale provides education and tools; final coding, billing, and appeals decisions remain the hospital's responsibility).

Payer Strategy and Market Access

• Own coding strategy for IntelliSep, including CPT/HCPCS and PLA code positioning (e.g., 0441U), and monitor MAC gapfill pricing and jurisdictional pricing decisions.
• Develop and execute payer engagement strategy, including national and regional plans and Medicare Advantage, to secure and expand coverage.
• Support publication and evidence strategy with health economics input, ensuring outcomes data is framed in ways that hold up with payers and guideline bodies (e.g., absolute risk reduction, NNT, relative risk reduction, presented in that order).
• Track the reimbursement and policy landscape relevant to sepsis diagnostics and flag risks or opportunities to commercial leadership.

Cross-Functional Leadership

• Partner closely with sales, marketing, sales enablement, medical affairs, and clinical evidence teams to ensure the ROI story and revenue cycle playbooks are integrated into the broader commercial narrative.
• Train and enable the field sales organization to identify revenue cycle opportunities at the account level and know when to bring in this function directly.
• Build and manage a small team over time as the function scales (consultants, analysts, market access managers).

Minimum Qualifications:

• 8+ years of experience in healthcare economics, market access, revenue cycle, hospital finance, or a closely related field, with meaningful exposure to hospital-side coding, billing, or reimbursement operations.
• Demonstrated ability to build and defend financial/economic models and present them credibly to senior hospital executives (CFO-level or above).
• Strong understanding of hospital reimbursement mechanics: DRGs, CC/MCC logic, denials and appeals processes, and how coding and documentation drive payment.
• Excellent executive presence and communication skills; comfortable in the room with hospital C-suite and board-level audiences.
• Ability to work hands-on with hospital coding/billing teams as well as at the strategic level with Cytovale leadership.

Additional Qualifications:

• Background in one or more of: hospital revenue cycle management, health system finance, HEMA/market access at a medical device or diagnostics company, or clinical/DRG coding and denials management (e.g., CDI, HIM, or consulting experience).
• Experience with diagnostics or medical device reimbursement, including PLA codes, gapfill pricing, and MAC/payer coverage processes.
• Familiarity with sepsis care, emergency medicine economics, or acute care quality measures (e.g., SEP-1) is a plus but not required.
• Prior experience building tools or playbooks that a customer-facing team can use independently, not just one-off analyses.

Success In This Role Looks Like:

• A standard of care changed, lives saved, hospital system operations improved.
• A credible, continuously refreshed ROI model that sales and marketing use consistently across accounts.
• A track record of hospital partners successfully identifying and capturing incremental revenue cycle value tied to IntelliSep, with documented case examples.
• Senior hospital leadership (CFO, VP Revenue Cycle) engagement at target accounts, with this role as a trusted advisor rather than a vendor presenting a pitch.
• Expanded and defended payer coverage, with clear visibility into coding and pricing risk.

Cytovale Culture: We're looking for a leader who will thrive in Cytovale's environment. The ideal candidate will be:

• Comfortable with ambiguity: You can move forward without perfect information and adjust quickly as new data emerges.
• High ownership, low ego: You take accountability for outcomes, seek feedback, and care more about impact than credit.
• Execution-focused: you don't just build strategies; you deliver results, iterate fast, and follow through.
• Intellectually curious: You enjoy digging into data, asking hard questions, and continuously improving your understanding.
• Resilient and adaptable: You stay steady and effective in a fast-paced, evolving environment.
• Mission-driven: You are motivated by Cytovale's goal to improve outcomes for patients and want your work to matter.