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Manager, Reimbursement

  • Cambridge, Massachusetts, United States
  • Full Time

About the Job

The Reimbursement Manager (RM) supports the company in achieving its mission to connect patients, providers, and payors and ensures patients can access Comprehensive Genomic Profiling through Foundation Medicine. This role serves as the point of contact supporting the field in all areas related to payor/field reimbursement of Company products. The RM assists the organization in execution of company strategies related to field reimbursement initiatives, including patient and health care provider HCP on-boarding and education, compliance, resources and communication. This position works independently to develop strong relationships with each account and through strategic work for prioritization, education, and support in a rapidly changing market. The RM works to ensure company products are appropriately reimbursed and patient reimbursement inquiries are resolved in a timely manner.

Key Responsibilities

• Serve as an internal and external subject matter expert on all questions or issues related to billing, coding and reimbursement.

• Educate and onboard new and existing customers on billing, how to complete prior authorization requirements, national and local payer coverage policies, and good clinical documentation practices.

• Act as the point of contact for billing, coding and reimbursement questions and partner with Sales to ensure an excellent customer experience.

• Collaborate with Access Operations Team, Payer Relations Team, Sales Team, and Market Access colleagues to develop, utilize, and improve internal systems, processes, and tools for improving patient access.

• Work with Field Managers, Field Sales Trainers, and Training Coordinators to execute field-based reimbursement training.

• Be an effective liaison through building and fostering relationships with many cross-functional teams and customers.

• Develop and maintain billing related training manuals and written processes.

• Constantly strive to build customer trust and confidence in FMI, through education on best billing practices.

• Maintain an in-depth understanding of customer needs and goals as it relates to ordering of CGP testing through FMI.

• Proactively communicate with customers and appropriate organizational departments regarding new or updated health plan updates and requirements.

• Work collaboratively to resolve any escalated billing issues through appropriate channels.

• Provide customer feedback related to billing processes back to the organization to leverage support and bring forward the appropriate resources within FMI.

• Alert the Field Team of potential opportunities to provide additional training and resources.

• Communicate policy developments to the company’s reimbursement management that could impact the reimbursement of company products.

• Create presentations and present to all levels of an organization.

• Participate in meetings and onsite visits with customers as needed.

• Other duties as assigned.


Basic Qualifications

• Bachelor’s degree in business or financial related field

• 6+ years of demonstrated experience in the reimbursement field

Preferred Qualifications

• Master’s degree in business, finance, or health care related field

• Supervisory/management experience

• Demonstrated ability to organize and communicate complex information in a clear and consistent manner to cross-functional audiences

• Demonstrated history of successfully managing multiple concurrent initiatives and maintaining one’s own workflow independently without significant day-to-day oversight

• Demonstrated ability to meet project deadlines

• Ability to diplomatically address sensitive issues confidentially and professionally and resolve conflicts

• Ability to interact professionally at multiple levels within a patient-and customer-oriented organization and develop trusting relationships

• Ability to condense complex information into a clear and precise picture

• Ability to facilitate resources to get problems solved

• Ability to work well under pressure while maintaining a professional demeanor

• Proficiency in Microsoft Excel and PowerPoint

• Expert knowledge of current reimbursement reporting rules and regulations

• Understanding of government and third-party payer reimbursement mechanisms

• Knowledge of medical terminology, CPT (Current Procedural Terminology) and ICD10

• Understanding of all aspects of Billing and Reimbursement to include but not limited to, charge entry, prior authorizations, electronic and paper billing, etc.

• Excellent verbal and written communication skills to work across functions and within external collaborations

• Strong interpersonal skills and professionalism in handling patient, provider and other group interactions across the organization

• Excellent presentation skills

• Strong organizational skills, analytical skills and problem-solving skills

• Excellent organization and attention to detail

• Understanding of HIPAA and importance of privacy of patient data

• Commitment to FMI Values: passion, patients, innovation, and collaboration


Please be aware that Foundation Medicine mandates COVID-19 vaccination of all employees regardless of work location. Accommodations may be made in accordance with applicable law.


About Foundation Medicine

Foundation Medicine, Inc. (FMI) began with an idea—to simplify the complex nature of cancer genomics, bringing cutting-edge science and technology to everyday cancer care. Our approach generates insights that help doctors match patients to more treatment options and helps accelerate the development of new therapies. Foundation Medicine is the culmination of talented people coming together to realize an important vision, and the work we do every day impacts real lives.

Confidence, or the belief that we need to check every box before applying for a job, can sometimes hold us back from going after a role that inspires us. At Foundation Medicine there's no such thing as the 'perfect' applicant, and our company is a place where every employee can make an impact and continue to grow whatever background they may have or path they may have taken. So, as long as you meet the basic qualifications for a role, please apply if you see a position that would make you excited to come into Foundation Medicine every day and help us transform cancer care.

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Internal applicants, please use your FMI email address.

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Foundation Medicine is proud to be an Equal Opportunity and Affirmative Action employer and considers all qualified applicants for employment without regard to race, color, religion, sex, gender, sexual orientation, gender identity, ancestry, age, or national origin. Further, qualified applicants will not be discriminated against on the basis of disability or protected veteran status. We also consider qualified applicants regardless of criminal histories, consistent with legal requirements. See also FMI’s EEO Statement and EEO is the Law and Supplement. If you have a disability or special need that requires accommodation, please let us know by completing this form.  (EOE/AAP Employer)

To all recruitment agencies: Foundation Medicine does not accept agency resumes. Please do not forward resumes to our jobs alias, Foundation Medicine employees or any other organization location. Foundation Medicine is not responsible for any fees related to unsolicited resumes.