Director, Reimbursement Operations

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