What are the responsibilities and job description for the Director, Reimbursement Operations position at Foundation Medicine?
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
Basic Qualifications
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.
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.
- 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