Senior Director, Reimbursement
Senior Director, Reimbursement
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Job Description
At Adaptive were Powering the Age of Immune Medicine. Our goal is to harness the power of the adaptive immune system to transform the way diseases are diagnosed and treated.
As an Adapter youll have the opportunity to make a difference in peoples lives. With Adaptive youll create a career highlight through collaboration with bright curious colleagues working at the apex of innovation and application.
Its time for your next chapter. Discover your story with Adaptive.
Position Overview
The Senior Director Reimbursement will oversee and manage the billing and reimbursement functions for Adaptives 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 Adaptives 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 thirdparty 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 Adaptives 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: Bachelors 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 ICD10 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 billingrelated 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 crossfunctional team environment
- Selfstarter ability to work independently and initiate tasks.
#LIRemote
Compensation
Salary Range: $204300 $306500
Other compensation elements include:
- equity grant
- bonus eligible
ALERT: Malicious groups posing as Adaptive employees have recently used fraudulent email aliases to extend employment offers provide fake documents and request sensitive personal and financial information. Legitimate Adaptive employment opportunities are initiated through our careers page and extended after multiple interviews with verified employees. Adaptive does not ask new hires to purchase anything outofpocket including home office supplies and equipment.
Interested in this position but dont meet all the requirements Adaptive is committed to building diverse equitable and inclusive teams across our organization. Please consider applying even if your experience doesnt match all the qualifications; you may be the exact candidate were searching for!
Adaptive is not currently sponsoring candidates requiring work authorization support for this position.
Adaptives posted compensation information includes a base salary (or hourly rate) range and summary of other available total compensation. The base salary range represents a minimumtomaximum salary (or hourly rate) available to candidates upon extension of offer. Base salary is thoughtfully considered upon offer and is determined through multiple evaluation checks throughout the interview process including: a candidates ability to meet minimum qualifications (skills/experience/education) a candidates ability to thoughtfully address preferred qualifications current market conditions and internal pay equity. Listed base salary is exclusive of bonus commission equity differential pay benefits and other incentives.
Adaptives benefits ataglance.
Adaptive Biotechnologies is an Affirmative Action and Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity national origin or protected veteran status and will not be discriminated against based on disability. Please refer theEqual Employment Opportunity Postersfor more information. If youd like to view a copy of the companys affirmative action plan or policy statement please email.
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NOTE TO EMPLOYMENT AGENCIES: Adaptive Biotechnologies values our relationships with our Recruitment Partners and will only accept resumes from those partners who have active agreements with Adaptive. Adaptive Biotechnologies is not responsible for any fees related to resumes that are unsolicited or are received by any employee of Adaptive Biotechnologies who is not a member of the Human Resources team.
Required Experience:
Exec
Employment Type
Full Time
