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Director, Billing Operations

Apply Share Job ID 1066 Category Commercial Operations Job Location Redwood City, California Posted Date 07/21/2018

Overview:

As the Director, Billing Operations, you are responsible for leading Genomic Health's reimbursement and billing operations and working closely with relevant departments to coordinate all aspects of the reimbursement and billing process. These critical partners include Managed Care, Finance, Customer Service, Analytics, Contract Management and Compliance.

Responsibilities/ duties:
· Create strategic and related tactical plan, to ensure GHI's reimbursement and billing services are extraordinary; establish service-level expectations to fully support our revenue goals
· Identify specific Billing and Reimbursement projects as they arise, allocate resources, ensure progress is tracked and meeting expectations and take corrective action, as required.
· Establish service expectations and measurement standards for Quadax, an external billing group, and Genomic Health's quarterly summits defining agendas and follow up on actions and priorities; establish key performance indictors ("KPIs") for billing vendor to ensure they are meeting expectations.
· Partner with the Chief Compliance Officer to develop and lead the Patient Assistance Program; develop guidelines and manage the implementation with billing vendor and the Billing Ops team to ensure accurate program adherence.
· Represent GHI at key industry conferences and Managed Care meetings; share learnings and insights with broader GHI community i.e. Managed Care, Corporate Communications, Sales & Marketing, and Senior Leadership.
· Partner with Managed Care Senior Director to prioritize projects, agree on shared metrics and outcomes for the teams, and ensure information and analytics are provided and understood. Keep Managed Care and other operations departments updated with relevant market or contract changes, important events, issues and concerns, and provide recommendations and directives for addressing.
· Establish critical KPI's and dashboards for the Billing and Ops team, with input from Managed Care and Commercial Analytics, to lead the revenue and reimbursement landscape and actions. Ensure that weekly Triad meetings between Managed Care, Operations and Contracts teams are being managed and follow up actions are completed.
· Direct and oversee plans to ensure SOPs are in place for benefits investigations, appeals and billing operations and that those SOPs are followed; Responsible for issue resolution by providing direction and recommendation for remediation.
· Take the lead position on advising IT on requirements and strategic vision for all systems relating to Billing Operations.
· Partner with Director of Customer Service to ensure that billing vendor adheres to all established policies and service level agreements as they pertain to benefits investigations and customer interactions, and that agreed changes to any part of the combined process are correctly implemented.
· As the Subject Matter Expert ("SME"), represent the Revenue and Reimbursement perspective on Order to Cash process discussions and improvements; SME on Billing and Reimbursement integration for US Commercial partnerships.
· Manage the Billing and Reimbursement team and vendor are monitoring claims activity to ensure policies are followed; present to Senior Leadership recommendations for changes to policies where appropriate.
· Negotiate complex contract terms with billing vendor and ensure that all contract terms are appropriately followed.

Qualifications
· Strong communication skills, both verbal & written; ability to maintain open communication with internal employees, managers and customers as needed
· Ability to influence others without the use of direct authority
· Demonstrates flexibility in an ambiguous, changing environment; effectively manages time through strong organizational skills
· Promote collaboration & partnerships with people from multiple departments and organizations
· Ability to understand complex processes and find ways to improve those processes.
· Extensive project management/coordination skills with an ability to quickly grasp and understand new concepts
· Broad understanding of healthcare insurance, reimbursement, and billing
· Bachelors Degree; 15+ years of commercial experience in either the clinical laboratory / pharmaceutical or healthcare industries; 3+ years in management
· Able to integrate and apply feedback in a professional manner
· Able to prioritize and work towards results with a high emphasis on quality

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As the Director, Billing Operations, you are responsible for leading Genomic Health's reimbursement and billing operations and working closely with relevant departments to coordinate all aspects of the reimbursement and billing process. These critical partners include Finance, Customer Service, Analytics, Contract Management and Compliance
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If you want to be part of a team that prides itself in teamwork and developing cutting-edge technology at Genomic Health, apply today!