Consultant, Medicare Policy and Market Access

Avalere Health is seeking a Consultant to join its Market Access & Reimbursement group.

The Market Access practice focuses on a wide range of areas, such as coverage, coding, and payment across commercial and public payers; pricing and contracting; and patient support services. We assess how our clients’ products fit within the emerging coverage and reimbursement landscape and help our clients optimize market access for their products though deep subject-matter expertise and understanding of their business issues.


  • Serving as a subject-matter expert on Medicare policy, reimbursement, and market access-related issues impacting the pharmaceutical, biotech, and medical device industries
  • Identifying opportunities and executing strategies for obtaining separate, unique Medicare payment in various settings of care
  • Monitoring, digesting, informing team members of relevant health policy changes
  • Assisting with projects and teams to solve complex client problems and engage clients with novel solutions and ideas
  • Creating both strategic and tactical recommendations for clients to ensure optimal market access for client products
  • Conceptualizing the scope of projects for clients, assembling a cross-functional team, and overseeing the team from project initiation through to client delivery
  • Understanding analyses and insights of other entities (e.g., CMS, MEDPAC, ICER, client proprietary Data on File)
  • Presenting qualitative and quantitative results to both technical and nontechnical audiences, in formats such as PowerPoint
  • Directly interacting with clients and other stakeholders, either in person or via teleconference or email
  • Complying with all security policies/procedures
  • Maintaining compliance with Inovalon’s policies, procedures, and mission statement
  • Adhering to all confidentiality and HIPAA requirements as outlined within Inovalon’s operating policies and procedures in all ways and at all times with respect to any aspect of the data handled or services rendered in the undertaking of the position
  • Fulfilling those responsibilities and duties that may be reasonably provided by Inovalon for the purpose of achieving operational and financial success of the company
  • Upholding responsibilities relative to the separation of duties for applicable processes and procedures within your job function

We reserve the right to change this job description from time to time as business needs dictate and will provide notice of such.

Skills, Experience, and Other Job-Related Requirements

Education Requirements

  • Bachelor’s degree in health policy, public policy, healthcare management, public health, public administration, health economics, business administration, law, or a relevant discipline

Skill Requirements

  • A strong interest in and a solid foundational knowledge of Medicare payment systems (e.g., inpatient hospital, outpatient hospital, physician office, Medicare Part B vs. D, and other payment setting/schedule)
  • Knowledge of existing claims and coding systems such as CPT, HCPCS, NDC, and ICD-10
  • Demonstrated analytic and quantitative skills
  • Excellent written and oral communication skills
  • A willingness to learn complex issues relating to the health care delivery system
  • Initiative, working independently with minimal supervision
  • Ability to work in teams
  • A positive, professional, and solution-oriented attitude

Experience Requirements

  • At least 4 years of relevant experience; examples of relevant work experience include consulting firms, hospital administration, device and pharmaceutical manufacturers, and the healthcare industry at large
  • Experience in managing multiple deadlines
  • Advanced experience with the Microsoft Office Suite
  • Preference for prior experience at one or more of the following: CMS, OMB, MedPAC, hospital system, or similar

Avalere is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected veteran status.

Consistent with our safety protocols, the company will require a vaccination attestation for fully office-based and hybrid (office/remote) positions. Positions designated as fully remote are exempt from the attestation requirement unless and until such time as an in-office presence is required.