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 Foundation Medicine'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 Foundation Medicine's values: Integrity, Courage, Passion
The expected salary range for this position based on the primary location of Boston, MA is $165,680 - $207,100 per year. The salary range is commensurate with Foundation Medicine's compensation practice and considers factors including, but not limited to, education, training, experience, external market conditions, criticality of role, and internal equity. A discretionary annual bonus may be available based on individual and Company performance.This position also qualifies for Foundation Medicine's benefits.
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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 Foundation Medicine's values: Integrity, Courage, Passion
The expected salary range for this position based on the primary location of Boston, MA is $165,680 - $207,100 per year. The salary range is commensurate with Foundation Medicine's compensation practice and considers factors including, but not limited to, education, training, experience, external market conditions, criticality of role, and internal equity. A discretionary annual bonus may be available based on individual and Company performance.This position also qualifies for Foundation Medicine's benefits.
#LI-Hybrid
#J-18808-Ljbffr