Senior Director, Reimbursement – Oncology

This is a fully remote position, open to applicants in United States.

📋 Description

• Serve as the company's subject matter expert in billing and payment strategies, concentrating on enhancing revenue cycle management and maximizing reimbursements.

• Lead a team responsible for the approval and accurate processing of patient claims while ensuring high customer satisfaction levels.

• Supervise the design and implementation of a Patient Financial Assistance Program.

• Create internal metrics and optimization strategies for reimbursement data and historical analysis.

• Collaborate with both internal and external software developers to facilitate automated workflows and improve process efficiency within revenue cycle management.

• Direct the strategy and development of scalable internal operational policies and Standard Operating Procedures (SOPs).

• Establish and maintain partnerships with payers and providers.

• Ensure that contracts are properly loaded and that claims adjudication is consistently managed in line with contractual and regulatory requirements.

• Work with internal and external stakeholders to address patient billing and provider concerns.

• Oversee and support billing operations and administration to ensure efficient, effective, and compliant revenue cycle management.

• Collaborate with finance on Financial Planning & Analysis (FP&A), Sarbanes-Oxley (SOX) compliance, and the determination of Average Selling Price (ASP) for products.

• Offer reimbursement guidance for the commercialization of new tests.

⛳️ Requirements

• Over 15 years of total professional experience.

• More than 5 years of experience in Reimbursement and Billing within a life sciences or payer environment.

• At least 5 years of management experience leading a billing team.

• A Bachelor’s degree is required.

• A graduate degree in a related field such as public health or public policy is preferred.

• Willingness to travel up to 15%.

• Experience interacting with payers as a laboratory that bills for molecular tests.

• Familiarity with federal and state legislative frameworks and regulatory processes.

• Proficiency in medical billing, third-party payers, patient interface, privacy, and confidentiality.

• Knowledge of SOP development in a HIPAA-compliant setting, as well as molecular billing codes and regulations.

• Experience in people management and vendor oversight.

• Strong analytical skills and the ability to engage with various software tools.

• Proficiency in Excel is essential.

• SQL or other database skills are a plus.

• Program management and systems engineering skills are highly beneficial.

• Experience with AI or PowerAutomate is a significant advantage.

• A curious mindset, sound judgment, and the capability to critically assess and responsibly utilize AI-enabled tools in accordance with company policies, ethical standards, and regulatory guidelines.

• Background screening, including a criminal history check, is mandatory.

🏝️ Benefits

• Hybrid work model allowing for work-from-home days for eligible onsite employees.

• Flexible work-life balance through scheduled in-office and focused work-from-home days.

• Reasonable accommodations available for candidates with disabilities, long-term conditions, mental health issues, or sincerely held religious beliefs.