Director, Reimbursement Operations - Military veterans preferred

Foundation Medicine, Inc.

• Full Time

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

About Foundation Medicine

Confidence, or the belief that we need to check every box before applying for a job, can sometimes hold us back from going after a role that inspires us. At Foundation Medicine there's no such thing as the 'perfect' applicant, and our company is a place where every employee can make an impact and continue to grow whatever background they may have or path they may have taken. So, as long as you meet the basic qualifications for a role, please apply if you see a position that would make you excited to come into Foundation Medicine every day and help us transform cancer care.

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