Senior Director, Reimbursement – Oncology

Job Description:

• Act as company subject matter expert in billing and payment strategy, focusing on optimizing revenue cycle management and maximizing reimbursement
• Manage a team responsible for approval and correct processing of patient claims with high customer satisfaction
• Oversee the design and build of a Patient Financial Assistance Program
• Develop internal metrics and optimization strategies for reimbursement data and history
• Partner with internal and external software developers to enable automated workflows and process efficiency for revenue cycle management
• Oversee strategy and development of scalable internal operational policies and SOPs
• Build and sustain partnerships with payers and providers
• Ensure contracts are loaded and claims adjudication is managed consistently with contractual and regulatory language
• Collaborate with internal and external stakeholders to resolve patient billing and provider issues
• Manage and support billing operations and administration for efficient, effective, and compliant revenue cycle management
• Interface with finance on FP&A, SOX, and determination of ASP for products
• Provide reimbursement guidance for commercialization of new tests

Requirements:

• 15+ years total experience
• 5+ years of professional experience in Reimbursement and Billing in a life sciences or payer setting
• 5+ years of management experience with a billing team
• Bachelor’s degree required
• Graduate degree in a related field such as public health or public policy preferred
• Open to travel up to 15%
• Experience working with payers as a laboratory that bills molecular tests
• Knowledge of federal and state legislative environments and regulatory processes
• Expertise in medical billing, third-party payers, patient interface, privacy, and confidentiality
• Knowledge of SOP development in a HIPAA-compliant environment and molecular billing codes and regulations
• Experience in people management and vendor management
• Strong analysis skills and ability to interface with a variety of software tools
• Excel skills mandatory
• SQL or other databasing skills desirable
• Program management and systems engineering skills a significant plus
• AI or PowerAutomate experience a significant plus
• Curiosity, sound judgment, and ability to critically evaluate and responsibly leverage AI-enabled tools in accordance with company policies, ethical standards, and regulatory requirements
• Background screening including criminal history required

Benefits:

• Hybrid work model with work-from-home days for eligible onsite employees
• Flexible work-life balance through scheduled in-office and focused work-from-home days
• Reasonable accommodations for candidates with disabilities, long-term conditions, mental health conditions, or sincerely held religious beliefs