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Director, Reimbursement Operations
Director, Reimbursement OperationsFoundation Medicine • Boston, MA, United States
Director, Reimbursement Operations

Director, Reimbursement Operations

Foundation Medicine • Boston, MA, United States
19 days ago
Job type
  • Full-time
Job description

About the Job

The Director of Reimbursement Operations develops and implements strategies that ensure service excellence, high-performing team collaboration and overall operational health. The incumbent leads initiatives to enhance revenue cycle operations and fosters a comprehensive, ROI-driven approach to FMI’s prioritization of revenue opportunities.

Key Responsibilities

  • Manage partnership with third-party vendor to maintain a high-performing revenue cycle team.
  • Collaborate across the Revenue & Access and vendor leadership teams to identify opportunities that impact revenue cycle performance.
  • Manage and oversee the activities supporting the full revenue cycle :

Commercial Health Plan Credentialing

  • Medicare Provider Credentialing
  • Medicaid claims and payment enrollment at vendor
  • Contract review (redline), set up and communication to vendor
  • Annual PAMA submission
  • Payer analytics
  • Reimbursement and outcomes
  • ROI activity
  • Model billing fees / annual and long-range planning
  • Invoice review and approval
  • Quarterly write-offs – analysis oversight and approval
  • Participate in team huddles
  • Special projects
  • Develop, implement, and manage metrics to measure and enhance performance.
  • Support field teams with customer meetings.
  • Analyze financial data to identify trends and areas of improvement in the reimbursement process.
  • Management and development of direct report(s).
  • Other duties as periodically assigned.
  • Qualifications

    Basic Qualifications

  • Bachelor’s degree in Healthcare Information or related fields, or equivalent work experience
  • 10+ years of professional work experience
  • 5+ years managerial experience
  • 5+ years of experience in healthcare and medical billing
  • Extensive experience with pivot tables to aggregate and analyze large financial datasets, identifying key trends and insights. Proficient in creating financial models, charts, and visualizations to inform critical financial decisions; highlight expertise in structuring complex spreadsheets for clarity.
  • Preferred Qualifications

  • Master’s or other Advanced Degree
  • Experience working within deadline and resource constraints
  • Prior experience working with intercultural teams
  • Demonstrated ability to lead an existing team of employees at different levels of their career
  • Ability to guide individuals and groups toward desired outcomes, setting high performance standards and delivering leading quality services
  • Ability to prioritize as necessary in a fast-paced environment
  • Ability to work well under pressure while maintaining a professional demeanor
  • Analytical thinking and solutioning skills
  • Effective and clear communication and presentation skills
  • Strong inter-personal skills with the ability to work cross-functionally to accomplish objectives
  • Willingness to adapt and work in ambiguous and / or changing conditions
  • Understanding of HIPAA and importance of privacy of patient data
  • Commitment to reflect FMI’s values : passion, patients, innovation, and collaboration
  • #LI-Hybrid

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    Director Reimbursement • Boston, MA, United States

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