Senior Director, Reimbursement

Position Overview

The Senior Director, Reimbursement will oversee and manage the billing and reimbursement functions for Adaptive’s CLIA lab service, working with physicians, payors, and patients. This role will manage a team of both home office and remote reimbursement and appeals managers, reimbursement operations coordinators, payer relations specialists, and reimbursement account specialists while also coordinating the efforts of strategic vendor partners. The successful candidate will work with the revenue cycle management team to design and implement strategies and tactics to improve revenue capture for the CLIA testing service. The Senior Director, Reimbursement will partner with a multidisciplinary team including Clinical Services, Finance, Medical, and other executives to ensure that Adaptive’s billing and reimbursement services operate efficiently and effectively.

Key Responsibilities and Essential Functions

• Oversee and manage the Reimbursement department
• Optimize billing processes for our diagnostic product lines
• Work effectively with third-party vendors on software and service solutions.
• Oversee the appeals process, ensure compliance with all applicable regulations and laws, manage efficient processing of appeals, and collaborate with medical and commercial teams to create appeals documentation in response to medical policy denials.
• Oversee and manage the prior authorization process, ensuring timely and accurate submission of prior authorization requests, and work closely with payors to resolve any issues that arise.
• Identify, manage, and report critical metrics and trends in reimbursement, and develop monthly and quarterly reports for key stakeholders.
• Work closely with the Market Access and Field Account teams on innovative programs that will enhance customer satisfaction and company profitability.
• Oversee, manage, and define areas for improvement in Adaptive's Patient Support Program.
• Lead initiatives to bring innovation to reimbursement operations, including the implementation of advanced technologies such as generative AI to streamline processes and improve efficiency.
• All other duties as assigned

Position Requirements (Education, Experience, Other)

Required

• Education: Bachelor's Degree.
• Minimum of 17 years experience in billing, reimbursement and customer service in the CLIA laboratory services sector, pathology, and oncology industry preferred. Commensurate experience in other healthcare provider settings will be considered.
• Direct knowledge of ICD-10 codes, CPT codes, and general billing practices in the laboratory services space.
• Significant experience with Medicare, Medicaid, Commercial and Other Governmental payers, as well as Laboratory Benefit Managers (LBMs).
• Proven track record of improving processes and solving problems
• Strong people management skills and experience
• Highly analytical, experienced in manipulating large data sets, summarizing observations, and making recommendations to management.
• Experience in implementing and monitoring appeals processes for both commercial and government payers.
• Proven track record of bringing innovation to reimbursement operations, with experience in implementing advanced technologies, including generative AI.
• Demonstrated ability to work effectively with physician office clients and patients on billing-related matters
• Ability to integrate and lead across multiple functions
• Strong interpersonal skills and experience in navigating organizational dynamics
• Excellent team player - highly effective working in a cross-functional team environment
• Self-starter - ability to work independently and initiate tasks.

#LI-Remote

Compensation

Salary Range: $204,300 - $306,500

Other compensation elements include:

• equity grant
• bonus eligible