Director, Billing and Reimbursement

Summary

Join Foresight Diagnostics, a venture-backed molecular diagnostics company, as their Director, Billing & Reimbursement. Lead the company's diagnostic billing operations, ensuring efficient revenue cycle processes and compliance. Oversee end-to-end billing, including claims, denials, and payer contracting. Collaborate with payers and internal teams to optimize reimbursement and minimize denials. Maintain regulatory compliance and manage a high-performing billing team. This role offers a competitive salary, equity, and comprehensive benefits.

Requirements

• Bachelor’s degree in healthcare administration, finance, business, or a related field
• Minimum of 7-10 years in laboratory billing, revenue cycle management, or payer contracting, with at least 3 years in a leadership role
• Deep knowledge of molecular diagnostics billing, CPT coding, Medicare and commercial payer requirements, and prior authorization processes
• Experience with laboratory information systems (LIS), electronic health record (EHR) billing, and revenue cycle management software
• Strong analytical, problem-solving, and leadership skills
• Ability to work cross-functionally and communicate complex billing matters effectively

Responsibilities

• Oversee and manage all aspects of the billing process, including claims submission, coding, payment posting, and accounts receivable
• Develop and implement best practices to maximize clean claim rates, reduce denials, and improve collection timelines
• Ensure compliance with all regulatory requirements, including Medicare, Medicaid, and commercial payer billing policies
• Optimize billing workflows, technology systems, and automation to improve efficiency and reduce errors
• Collaborate with payers ensure proper coding, coverage, and reimbursement for MRD diagnostics
• Support the Foresight market access team during contract negotiations with commercial payers and government programs to improve reimbursement rates and minimize claim denials
• Monitor changes in payer policies and advocate for favorable reimbursement policies for MRD testing
• Ensure billing practices align with state and federal regulations, including CMS guidelines, HIPAA, and fraud prevention laws
• Work closely with legal, compliance, and finance teams to mitigate billing risks and maintain accurate documentation
• Lead internal billing audits and support external payer audits or reviews
• Manage third party revenue cycle managers, ensuring performance to contract and driving successful billing outcomes
• Manage and develop a high-performing billing team, including billing specialists, coders, and claims resolution staff
• Partner with finance, market access, sales, and lab operations teams to ensure seamless revenue cycle operations
• Provide training and ongoing education on billing policies and best practices for internal teams

Preferred Qualifications

MBA or CPC certification

Benefits

• Annual salary of $193,375 - $218,500
• Equity offerings
• Paid vacation
• Sick time
• Parental leave (if applicable)
• Medical, dental, vision, life, disability coverage
• Flexible spending accounts
• 401k with company match
• Professional development