SUMMARY
The Director, Revenue & Reimbursement Operations, reporting to the VP, Market Access and Value, will strategize, lead, direct and support Prometheus Labs driving Order to Cash excellence. Focused on infrastructure and operational strategy of the teams, this role serves as the right hand to finance and reporting for all revenue related customer-facing commercial operations functions. Ensuring day to day and long-term stability, success, and compliance within the core infrastructure, processes, information and data deliverables. The position will lead a team that provides analytical insights to drive process and cost-efficient operational results while maximizing revenue pull through from all commercial bill types. Develop a structure for innovation and establish a strong cross department collaboration to transform delivery and customer experience.

The Leader is responsible for improving transparency in revenue cycle operations through data supported analysis of key metrics. This includes supporting operational processes and performance as well as identifying gaps in resources and or financial planning and control activities that should be addressed within the Revenue & Reimbursement Operations teams. The Leader builds project plans to help guide initiatives through implementation and delivery for seamless integrations and connections. The Leader will leverage LSS skills in project management, data driven decision making, team building and consultation to optimize the department.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

• Establish, direct and execute at a high level all reimbursement strategy, goals and objectives of the department.
• Engage with business partners and stakeholders to identify opportunities and understand current processes - Denial task force, enhanced appeals, clean claims targets.
• Proactive in communication, relationship building, gap identification, risk mitigation, change management and all elements of initiative execution.
• Leads team of billing, contact center, and analytical staff.
• Designs and implements systems infrastructure needs to mature the organizations' ability to deliver high quality solutions.
• Identifies and communicates potential compliance risk.
• Analyzes business requirements for data and reporting needs and systems.
• Works to increase payor, patient and clinical customer experience through enhanced services and automations.
• Evaluates operations with regard to established corporate goals.
• Develop performance standards and programs to manage internal billing teams.
• Assesses need for software, vendors and third party supported functionality.
• Prepares and delivers timely and actionable communications, data with deep insights for upper management.
• Establish, maintain and expand relationships with internal key stakeholders, external and outsource vendors.
• Support a diverse and inclusive culture in which all staff have a shared vision and purpose.

QUALIFICATIONS

• Expert understanding of healthcare industry, laboratory coding, billing and coverage complexities, billing software systems, functionality requirements, HIPAA and other compliance requirements.
• Strong interpersonal, communication and leadership skills to collaborate and partner with business functions and individuals to achieve goals.
• Ability to manage and prioritize tasks and projects across multiple workstreams.
• Solid working knowledge of all relevant coding languages and security protocols.
• Excellent analytical, facilitation and problem-solving skills with the ability to interpret and anticipate customer needs.
• Servant leadership oriented.

EDUCATION and/or EXPERIENCE

• Bachelor's degree in a related field or 10 + years of progressive Revenue Cycle related leadership experience
• Minimum eight years' experience working in laboratory or diagnostic test industry
• Minimum three years' experience overseeing large internal or outsources teams and projects
• Certifications and continuing education preferred
• Consulting Experience a plus
• Healthcare financial reporting knowledge, Revenue recognition standards a plus
• Experience in healthcare administrative workflow redesign
• Travel required 25% of the time

LANGUAGE SKILLS
Ability to read, analyze, and interpret common scientific and technical journals, financial reports, and legal documents. Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community. Ability to write speeches and articles for publication that conform to prescribed style and format. Ability to effectively present information to top management, public groups, and/or boards of directors.

MATHEMATICAL SKILLS
Ability to work with mathematical concepts such as probability and statistical inference, and fundamental of plane and solid geometry and trigonometry. Ability to apply concepts such as fractions, percentages, rations, and proportions to practical situations.

REASONING ABILITY
Ability to define problems, collect data, establish facts and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.

CERTIFICATES, LICENSES, REGISTRATIONS

None required.

PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit and talk or hear. The employee frequently is required to use hands to finger, handle, or feel. The employee is occasionally required to stand, walk, and reach with hands and arms. The employee must occasionally lift and/or move up to 25 lbs.

Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception, and ability to adjust focus.

WORK ENVIRONMENT
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

All qualified applicants are considered for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status or other protected class.

The statements herein are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.