Reimbursement director job description
Updated March 14, 2024
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Example reimbursement director requirements on a job description
Reimbursement director requirements can be divided into technical requirements and required soft skills. The lists below show the most common requirements included in reimbursement director job postings.
Sample reimbursement director requirements
- Extensive knowledge of healthcare reimbursement policies and regulations
- Experience with Medicare and Medicaid billing procedures
- Strong analytical and financial management skills
- Bachelor's degree in healthcare administration, finance, or related field
- Minimum of 5 years of experience in a reimbursement management role
Sample required reimbursement director soft skills
- Excellent communication and interpersonal skills
- Strong leadership and team management abilities
- Ability to develop and maintain strong relationships with payers and providers
- Proven track record of developing and implementing successful reimbursement strategies
- Ability to stay current with industry trends and developments
Reimbursement director job description example 1
University of Maryland Medical System reimbursement director job description
What You Will Do:
Position: Director ReimbursementShift: M-F 8A-5PLocation: Linthicum, MDAt the University of Maryland Medical System (UMMS), the health of Maryland is our mission - and our passion. We are the one health system that is focused on our state and delivering healthcare that's made for Marylanders. Being among the top 25 employers in the state and recently recognized as America's Best Large Employer 2021 by Forbes, UMMS brings together a diverse and collaborative team of innovators committed to caring for our Marylanders, advancing medicine, and transforming lives. At UMMS, people are our priority - and that includes our patients, our community and our employees. We take your wellbeing, growth and work-life balance seriously.UMMS is seeking a Director of Reimbursement. The Director of Reimbursement leads and directs the operations of the Reimbursement and Revenue Advisory Services department for the University of Maryland Medical System. Manages, recruits, coaches and develops reimbursement managers & staff within his/her specialized function. Responsible for proposing, implementing, reviewing, and modifying all work related to revenue maximization strategies in compliance with HSCRC, federal, state, and local laws/regulations. Responsibilities and Tasks
The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. These are not to be construed as an exhaustive list of all job duties performed by personnel so classified.
+ Leads and directs a team of managers and staff in accordance with departmental and UMMS personnel policies and procedures.
+ Responsible for identifying and addressing potential revenue enhancement opportunities by collaborating with cross-functional teams and other departments.
+ Collaborates with senior leadership to establish strategic goals by gathering pertinent business, financial, service and operations information; to identify and evaluate trends and options; chooses a course of action; defines objectives; evaluates outcomes.
+ Communicates regularly with decision support, financial reporting, hospital departments, health information management (HIM), clinicians, UM School of Medicine, and others to ensure compliance of all regulations and optimal effectiveness of financial reporting.
+ Keeps abreast of current regulatory information/guidelines and coaches others to do the same; communicates relevant changes and/or protocol and procedural revisions to senior management and staff. Implements appropriate departmental operational changes to ensure compliance. Participates in and works to influence HSCRC and industry meetings and workgroups.
+ Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
As an UMMS Team Member, you'll experience:
+ A supportive and collaborative work environment.
+ A comprehensive benefits package including health, vision and dental coverage including prescription drug coverage - Tax-Free Savings Plans, Tuition Reimbursement and more!
+ Work Life Balance: You'll accrue annual leave; we offer dependent care reimbursement, short/long term disability and an employee assistance program.
+ Growth & Educational Assistance: We support your continuing education and career advancement by offering tuition reimbursement & continuing education options.
What You Need to Be Successful:
Education and Experience
+ Bachelor's degree is required. Specialization in Healthcare, Finance, Accounting or equivalent related subject is preferred.
+ Seven (7) years professional financial, reimbursement, or analysis experience is required.
+ Five (5) years supervisor or manager experience is required.
+ Healthcare-related finance background is preferred.
We are an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.
Position: Director ReimbursementShift: M-F 8A-5PLocation: Linthicum, MDAt the University of Maryland Medical System (UMMS), the health of Maryland is our mission - and our passion. We are the one health system that is focused on our state and delivering healthcare that's made for Marylanders. Being among the top 25 employers in the state and recently recognized as America's Best Large Employer 2021 by Forbes, UMMS brings together a diverse and collaborative team of innovators committed to caring for our Marylanders, advancing medicine, and transforming lives. At UMMS, people are our priority - and that includes our patients, our community and our employees. We take your wellbeing, growth and work-life balance seriously.UMMS is seeking a Director of Reimbursement. The Director of Reimbursement leads and directs the operations of the Reimbursement and Revenue Advisory Services department for the University of Maryland Medical System. Manages, recruits, coaches and develops reimbursement managers & staff within his/her specialized function. Responsible for proposing, implementing, reviewing, and modifying all work related to revenue maximization strategies in compliance with HSCRC, federal, state, and local laws/regulations. Responsibilities and Tasks
The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. These are not to be construed as an exhaustive list of all job duties performed by personnel so classified.
+ Leads and directs a team of managers and staff in accordance with departmental and UMMS personnel policies and procedures.
+ Responsible for identifying and addressing potential revenue enhancement opportunities by collaborating with cross-functional teams and other departments.
+ Collaborates with senior leadership to establish strategic goals by gathering pertinent business, financial, service and operations information; to identify and evaluate trends and options; chooses a course of action; defines objectives; evaluates outcomes.
+ Communicates regularly with decision support, financial reporting, hospital departments, health information management (HIM), clinicians, UM School of Medicine, and others to ensure compliance of all regulations and optimal effectiveness of financial reporting.
+ Keeps abreast of current regulatory information/guidelines and coaches others to do the same; communicates relevant changes and/or protocol and procedural revisions to senior management and staff. Implements appropriate departmental operational changes to ensure compliance. Participates in and works to influence HSCRC and industry meetings and workgroups.
+ Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
As an UMMS Team Member, you'll experience:
+ A supportive and collaborative work environment.
+ A comprehensive benefits package including health, vision and dental coverage including prescription drug coverage - Tax-Free Savings Plans, Tuition Reimbursement and more!
+ Work Life Balance: You'll accrue annual leave; we offer dependent care reimbursement, short/long term disability and an employee assistance program.
+ Growth & Educational Assistance: We support your continuing education and career advancement by offering tuition reimbursement & continuing education options.
What You Need to Be Successful:
Education and Experience
+ Bachelor's degree is required. Specialization in Healthcare, Finance, Accounting or equivalent related subject is preferred.
+ Seven (7) years professional financial, reimbursement, or analysis experience is required.
+ Five (5) years supervisor or manager experience is required.
+ Healthcare-related finance background is preferred.
We are an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.
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Reimbursement director job description example 2
SmartVest Airway Clearance System reimbursement director job description
People Purpose: Beyond Competitive
It is no longer ok to just be competitive regarding how we treat our people in everything we do. Our leadership team believes wholeheartedly we need to be beyond competitive and cultivate a culture of proud, driven employees who are passionate about the work they do and where they do it. Our leadership strives to unleash unsurpassed potential in every team and individual employed and owns making that happen. Sincere, Simple, Smart.
What makes us Beyond Competitive:
* Discretionary Time Off
* Management bonus plan
* Flexible hybrid/remote work options
* Full pay maternity, paternity, parental, short-term disability leaves
* Employee driven recognition program
* Access to hundreds of training opportunities
* Company paid educational assistance
* Well-being on demand
* Perks at Work
* Competitive health and welfare plans -HSA company contribution
* 401(k) company match
* Great culture and people!
The Opportunity:
The Director, Reimbursement & Payer Relations is responsible for leading and integrating Electromed's revenue cycle functions including our billing, reimbursement, payer relations, and appeals teams with a patient centric focus that best maximizes the collection of national reimbursements and payments as well as identifying ongoing patient engagement and reimbursement improvement opportunities. The position is responsible for maintaining long term patient-payer related contracts that ensure the company remains in compliance with federal and state regulations and accreditation requirements. The Director is also responsible for all new and existing contracted relationships with HMO/POS/PPO, Medicare, state Medicaid programs and MCO providers including renewals, terminations and negotiation of payer agreements.
The Director, Reimbursement & Payer Relations will establish a work environment of continuous improvement that supports our revenue stream, while exceeding our patients' expectations and ensuring employee engagement. The role will be highly involved in both strategic planning as well as tactical operations.
Job Outcomes You Must Get:
* Follow Electromed mission and core values, while striving to achieve company goals.
* Understands and adheres to local State and Federal healthcare regulatory and compliance rules.
* Develops and maintains departmental policies and procedures in accordance with Electromed and insurance industry standards.
* Acts quickly and professionally toward resolving issues relative to patient service and employee engagement.
* Ensure optimal and accurate product reimbursement as outlined in our payer contracts.
* Analyzes payer reimbursement to identify deficiencies and mitigate revenue leakage.
* Provides oversight of underpayment and denial management of claims.
* Provides a high degree of expertise in revenue cycle operations, technical processes, report analysis, and payer policies and protocols.
* Develops, monitors, and communicates KPIs relevant to revenue cycle and payer relations.
* Identifies opportunities for improvement based on organizational needs and industry standards and maintains a culture of continuous process improvement.
* Analyzes accounts receivable to ensure maximum net revenue realization, stable cash collections, denial mitigation, and measured reduction in write offs.
* Be the lead strategist, negotiator, and contract expert for how Electromed works with existing and new payer relationships.
* Provide strategic approach to help the company grow by engaging at a deeper level with key payer providers to provide a competitive advantage to sales.
Job Outcomes Requirements:
* Bachelor's degree in business, healthcare administration, or health related field.
* 5+ years of healthcare reimbursement management experience leading cross-functional teams.
* 4+ years of clinic, DME, or hospital-related management of revenue cycle experience.
* Experience in professional billing and reimbursement in Medicare, Medicaid, and commercial insurances.
* Highly adaptable to stakeholder needs and eager to take on new challenges.
* Strong interpersonal skills and ability to interact with a range of internal and external customers.
* Excellent communication skills, including listening, writing, and presenting to groups of all sizes.
* Ability to work collaboratively with strong team building skills.
Be You.
Our people celebrate diverse individuals, backgrounds, and thinking. As an equal opportunity employer this is the absolute most important belief in cultivating our
culture and growth together.
Core Values
Unwavering passion for Patients. Make it happen. Encourage innovation and creativity.
Embrace change. Always do what's right. Listen, learn, and deliver.
Electromed develops, manufactures, and markets innovative airway clearance devices that help people around the world breathe better, stay healthier, and lead active and fulfilling lives.
Making Life's important moments possible-one breath at a time.
It is no longer ok to just be competitive regarding how we treat our people in everything we do. Our leadership team believes wholeheartedly we need to be beyond competitive and cultivate a culture of proud, driven employees who are passionate about the work they do and where they do it. Our leadership strives to unleash unsurpassed potential in every team and individual employed and owns making that happen. Sincere, Simple, Smart.
What makes us Beyond Competitive:
* Discretionary Time Off
* Management bonus plan
* Flexible hybrid/remote work options
* Full pay maternity, paternity, parental, short-term disability leaves
* Employee driven recognition program
* Access to hundreds of training opportunities
* Company paid educational assistance
* Well-being on demand
* Perks at Work
* Competitive health and welfare plans -HSA company contribution
* 401(k) company match
* Great culture and people!
The Opportunity:
The Director, Reimbursement & Payer Relations is responsible for leading and integrating Electromed's revenue cycle functions including our billing, reimbursement, payer relations, and appeals teams with a patient centric focus that best maximizes the collection of national reimbursements and payments as well as identifying ongoing patient engagement and reimbursement improvement opportunities. The position is responsible for maintaining long term patient-payer related contracts that ensure the company remains in compliance with federal and state regulations and accreditation requirements. The Director is also responsible for all new and existing contracted relationships with HMO/POS/PPO, Medicare, state Medicaid programs and MCO providers including renewals, terminations and negotiation of payer agreements.
The Director, Reimbursement & Payer Relations will establish a work environment of continuous improvement that supports our revenue stream, while exceeding our patients' expectations and ensuring employee engagement. The role will be highly involved in both strategic planning as well as tactical operations.
Job Outcomes You Must Get:
* Follow Electromed mission and core values, while striving to achieve company goals.
* Understands and adheres to local State and Federal healthcare regulatory and compliance rules.
* Develops and maintains departmental policies and procedures in accordance with Electromed and insurance industry standards.
* Acts quickly and professionally toward resolving issues relative to patient service and employee engagement.
* Ensure optimal and accurate product reimbursement as outlined in our payer contracts.
* Analyzes payer reimbursement to identify deficiencies and mitigate revenue leakage.
* Provides oversight of underpayment and denial management of claims.
* Provides a high degree of expertise in revenue cycle operations, technical processes, report analysis, and payer policies and protocols.
* Develops, monitors, and communicates KPIs relevant to revenue cycle and payer relations.
* Identifies opportunities for improvement based on organizational needs and industry standards and maintains a culture of continuous process improvement.
* Analyzes accounts receivable to ensure maximum net revenue realization, stable cash collections, denial mitigation, and measured reduction in write offs.
* Be the lead strategist, negotiator, and contract expert for how Electromed works with existing and new payer relationships.
* Provide strategic approach to help the company grow by engaging at a deeper level with key payer providers to provide a competitive advantage to sales.
Job Outcomes Requirements:
* Bachelor's degree in business, healthcare administration, or health related field.
* 5+ years of healthcare reimbursement management experience leading cross-functional teams.
* 4+ years of clinic, DME, or hospital-related management of revenue cycle experience.
* Experience in professional billing and reimbursement in Medicare, Medicaid, and commercial insurances.
* Highly adaptable to stakeholder needs and eager to take on new challenges.
* Strong interpersonal skills and ability to interact with a range of internal and external customers.
* Excellent communication skills, including listening, writing, and presenting to groups of all sizes.
* Ability to work collaboratively with strong team building skills.
Be You.
Our people celebrate diverse individuals, backgrounds, and thinking. As an equal opportunity employer this is the absolute most important belief in cultivating our
culture and growth together.
Core Values
Unwavering passion for Patients. Make it happen. Encourage innovation and creativity.
Embrace change. Always do what's right. Listen, learn, and deliver.
Electromed develops, manufactures, and markets innovative airway clearance devices that help people around the world breathe better, stay healthier, and lead active and fulfilling lives.
Making Life's important moments possible-one breath at a time.
Dealing with hard-to-fill positions? Let us help.
Reimbursement director job description example 3
Eisai reimbursement director job description
At Eisai, satisfying unmet medical needs and increasing the benefits healthcare provides to patients, their families, and caregivers is Eisai's human health care (hhc) mission. We're a growing pharmaceutical company that is breaking through in neurology and oncology, with a strong emphasis on research and development. Our history includes the development of many innovative medicines, notably the discovery of the world's most widely-used treatment for Alzheimer's disease. As we continue to expand, we are seeking highly-motivated individuals who want to work in a fast-paced environment and make a difference. If this is your profile, we want to hear from you.
The Director, Access & Reimbursement Team will be a field-based, second-line leader responsible for creating the vision and subsequent execution of the Oncology and Neurology access & reimbursement activities. This individual will lead the Associate Directors and their teams of Access & Reimbursement Managers (ARMs) to help ensure Market Access priorities are aligned on and met. The Director will possess deep and broad understanding of reimbursement and access trends across our healthcare landscape, as well as cross-functional business knowledge to drive Eisai's mission to create optimal access for patients and drive our human health care mission. This leader will work in the dynamic oncology environment and build a neurology ARM team with expertise in the medical benefit and infusion space. This role will have a lot of visibility as the Director will engage senior leadership and others regarding the complexities of access and reimbursement in the US Health Care system. The Director is responsible for field team budgets, meeting/exceeding key performance indicators, management monitoring and compliance with all policies and regulations.
· Consistently demonstrate uncompromised integrity while working cross-functionally and collaboratively with internal and external stakeholders. Strong understanding of legal and regulatory parameters related to patient access and support program services. Comply with all Eisai promotional and administrative policies and applicable law.
· Lead and motivate the Oncology & Neurology ARM team to support Market Access priorities
· Responsible for ensuring ARM Associate Directors and teams are meeting all their responsibilities
· Attracting, developing, empowering, and retaining their people by rewarding and recognizing strong performance by using innovative approaches to recognition and minimize regrettable attrition
· Work cross-functionally with appropriate Eisai stakeholders regarding access and reimbursement issues, including Payer Markets, Market Access and Reimbursement Services, Sales, Marketing, Government Affairs, Legal, Compliance, Medical, and Training. Provide educational opportunities so the Eisai ARM team is viewed as subject matter experts when it comes to accessing of and reimbursement for the Eisai portfolio of products
· Foster an inclusive and diverse work environment
· Provide internal expertise, education and understanding of the access & reimbursement environment and support the development of strategic solutions
· Prioritize and delegate special projects that create impact toward desired results
· Align to Eisai's Human Health Care (hhc) mission and foster a positive culture by focusing on what is right for the patient
· Serve as an escalation point for review, approval, and communication of next best actions to take in the case of patient-level access and reimbursement issues
· Monitors compliance to all processes & policies and puts procedures in place to minimize risks and continuously improve
Essential Elements for Success:
· Patient-Focused
· Action Oriented
· Problem Solving
· Priority Setting
· Drive for Results
· Strategic Agility
· Organizational Awareness
· Strategic Planning and Execution Capabilities
· Dealing with Ambiguity
· Personnel Coaching and Development
Requirements (Experience, Education, Skills, etc.)
· BA/BS Degree required
· 12 years experience in the pharmaceutical/healthcare industry
· 5+ years prior experience managing a team of field-based employees
· Specialty launch experience with Medicare NCD/CED, Medical Benefit, Miscellaneous J-code, and novice buy & bill provider (preferred)
· As a trusted advisor to business partners and executive management, this role requires seasoned judgment, strategic focus, and objective perspective. The successful candidate will possess the ability to see the entire landscape - Eisai, regulatory, legal, payer, patient, and all health care provider types
· Field based, but will require frequent travel to headquarters and will require East Coast Working Hours
· Valid driver's license
· Eisai requires all new hires to be fully vaccinated against COVID-19 and provide valid proof of vaccination as of their start date, to the extent permitted under applicable law. This requirement is a condition of employment at Eisai, and it applies regardless of whether the position is located at an Eisai site, field based or is fully remote. If you are unable to receive the vaccine for qualifying medial reasons (including pregnancy-related), or religious reasons (sincerely held religious beliefs), you will have an opportunity to request a reasonable accommodation.
Eisai requires all new hires to be fully vaccinated against COVID-19 and provide valid proof of vaccination as of their start date, to the extent permitted under applicable law. This requirement is a condition of employment at Eisai, and it applies regardless of whether the position is located at an Eisai site, field based or is fully remote. If you are unable to receive the vaccine for qualifying medical reasons (including pregnancy-related), or religious reasons (sincerely held religious beliefs), you will have an opportunity to request a reasonable accommodation.
Eisai is an equal opportunity employer and as such, is committed in policy and in practice to recruit, hire, train, and promote in all job qualifications without regard to race, color, religion, gender, age, national origin, citizenship status, marital status, sexual orientation, gender identity, disability or veteran status. Similarly, considering the need for reasonable accommodations, Eisai prohibits discrimination against persons because of disability, including disabled veterans.
Eisai Inc. participates in E-Verify. E-Verify is an Internet based system operated by the Department of Homeland Security in partnership with the Social Security Administration that allows participating employers to electronically verify the employment eligibility of all new hires in the United States. Please click on the following link for more information:
Right To Work
E-Verify Participation
The Director, Access & Reimbursement Team will be a field-based, second-line leader responsible for creating the vision and subsequent execution of the Oncology and Neurology access & reimbursement activities. This individual will lead the Associate Directors and their teams of Access & Reimbursement Managers (ARMs) to help ensure Market Access priorities are aligned on and met. The Director will possess deep and broad understanding of reimbursement and access trends across our healthcare landscape, as well as cross-functional business knowledge to drive Eisai's mission to create optimal access for patients and drive our human health care mission. This leader will work in the dynamic oncology environment and build a neurology ARM team with expertise in the medical benefit and infusion space. This role will have a lot of visibility as the Director will engage senior leadership and others regarding the complexities of access and reimbursement in the US Health Care system. The Director is responsible for field team budgets, meeting/exceeding key performance indicators, management monitoring and compliance with all policies and regulations.
· Consistently demonstrate uncompromised integrity while working cross-functionally and collaboratively with internal and external stakeholders. Strong understanding of legal and regulatory parameters related to patient access and support program services. Comply with all Eisai promotional and administrative policies and applicable law.
· Lead and motivate the Oncology & Neurology ARM team to support Market Access priorities
· Responsible for ensuring ARM Associate Directors and teams are meeting all their responsibilities
· Attracting, developing, empowering, and retaining their people by rewarding and recognizing strong performance by using innovative approaches to recognition and minimize regrettable attrition
· Work cross-functionally with appropriate Eisai stakeholders regarding access and reimbursement issues, including Payer Markets, Market Access and Reimbursement Services, Sales, Marketing, Government Affairs, Legal, Compliance, Medical, and Training. Provide educational opportunities so the Eisai ARM team is viewed as subject matter experts when it comes to accessing of and reimbursement for the Eisai portfolio of products
· Foster an inclusive and diverse work environment
· Provide internal expertise, education and understanding of the access & reimbursement environment and support the development of strategic solutions
· Prioritize and delegate special projects that create impact toward desired results
· Align to Eisai's Human Health Care (hhc) mission and foster a positive culture by focusing on what is right for the patient
· Serve as an escalation point for review, approval, and communication of next best actions to take in the case of patient-level access and reimbursement issues
· Monitors compliance to all processes & policies and puts procedures in place to minimize risks and continuously improve
Essential Elements for Success:
· Patient-Focused
· Action Oriented
· Problem Solving
· Priority Setting
· Drive for Results
· Strategic Agility
· Organizational Awareness
· Strategic Planning and Execution Capabilities
· Dealing with Ambiguity
· Personnel Coaching and Development
Requirements (Experience, Education, Skills, etc.)
· BA/BS Degree required
· 12 years experience in the pharmaceutical/healthcare industry
· 5+ years prior experience managing a team of field-based employees
· Specialty launch experience with Medicare NCD/CED, Medical Benefit, Miscellaneous J-code, and novice buy & bill provider (preferred)
· As a trusted advisor to business partners and executive management, this role requires seasoned judgment, strategic focus, and objective perspective. The successful candidate will possess the ability to see the entire landscape - Eisai, regulatory, legal, payer, patient, and all health care provider types
· Field based, but will require frequent travel to headquarters and will require East Coast Working Hours
· Valid driver's license
· Eisai requires all new hires to be fully vaccinated against COVID-19 and provide valid proof of vaccination as of their start date, to the extent permitted under applicable law. This requirement is a condition of employment at Eisai, and it applies regardless of whether the position is located at an Eisai site, field based or is fully remote. If you are unable to receive the vaccine for qualifying medial reasons (including pregnancy-related), or religious reasons (sincerely held religious beliefs), you will have an opportunity to request a reasonable accommodation.
Eisai requires all new hires to be fully vaccinated against COVID-19 and provide valid proof of vaccination as of their start date, to the extent permitted under applicable law. This requirement is a condition of employment at Eisai, and it applies regardless of whether the position is located at an Eisai site, field based or is fully remote. If you are unable to receive the vaccine for qualifying medical reasons (including pregnancy-related), or religious reasons (sincerely held religious beliefs), you will have an opportunity to request a reasonable accommodation.
Eisai is an equal opportunity employer and as such, is committed in policy and in practice to recruit, hire, train, and promote in all job qualifications without regard to race, color, religion, gender, age, national origin, citizenship status, marital status, sexual orientation, gender identity, disability or veteran status. Similarly, considering the need for reasonable accommodations, Eisai prohibits discrimination against persons because of disability, including disabled veterans.
Eisai Inc. participates in E-Verify. E-Verify is an Internet based system operated by the Department of Homeland Security in partnership with the Social Security Administration that allows participating employers to electronically verify the employment eligibility of all new hires in the United States. Please click on the following link for more information:
Right To Work
E-Verify Participation
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Updated March 14, 2024
Updated March 14, 2024