Director, Reimbursement Operations

Company: Foundation Medicine
Location: Boston
Posted on: May 6, 2025

Job Description:

About the JobThe 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.QualificationsBasic 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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Keywords: Foundation Medicine, Cranston , Director, Reimbursement Operations, Executive , Boston, Rhode Island