International Billing & Reimbursement Operations - Manager

Organization: 
Genomic Health, Inc.
Job Location: 
Redwood City, CA
Job Description: 

Facilitate implementation and revenue pull-through activities, proactive and reactive, with internal and external parties to ensure the public & private payer reimbursement, billing and payment processes are efficient, timely, and in compliance with corporate goals, contracts and/or regulations.

Responsibilities:
- Collaborate with International and Managed Care teams on development and rollout of new processes and reporting tools that address implementation and pull-through activities.
- Collaborate with billing partner to identify, analyze and determine next steps to address negative revenue pull-through scenarios specific to payers and across payer segments (E.g. partner/insurance/hospital set-up issues, insurance claims adjudication processes, etc.).
- Develop and leverage relationships with billing operations staff at payers for use in resolving claims adjudication (contractual and non-contractual) issues.
- Coordinate execution of pull-through plans in order to meet quarterly revenue goals and attain accrual status.
- Collaborate with International Commercial teams on developing resources to aid in payer conversations regarding prior authorization or related criteria validation processes.
- Facilitate conversations with appropriate GHI personnel early in the contracting process to provide an overview of the account to avoid delay in implementation down the road.
- Engage in conversations between GHI/Quadax and payers' operations personnel towards the end of the contract process, and follow up on action items. Assume revenue pull-through responsibility post contract execution.
- Synthesize lessons learned and update implementation and/or pull-through processes, plans and/or tools as needed.
- Develop and implement a plan for ongoing monitoring and communication of results of pull-through efforts.

QUALIFICATIONS
- 5-10 years billing experience within the healthcare industry including 3-5 years in the international market (preferably EU)
- Knowledge of and/or experience with public & private Managed Care payers and reimbursement process
- Understanding of market-related issues, contract development, negotiation, and pull through as well as the legal and regulatory implications associated with Private and Government payer contracting
- Effective communication skills, both written and oral across internal and external personnel - strong with PowerPoint
- Collaborative and works effectively as a team member
- Strong attention to detail and organizational skills
- Strong analytical skills and familiarity with Excel
- Ability to present recommendations supported by analytical evaluations
- Capable of prioritizing and managing several, complex projects at once
- Strong skills with Word
- Knowledge of and/or experience with government Managed Care payers and reimbursement process is a plus
- Knowledge of international billing and coding is a plus
- Ability to influence without authority
- Capable of identifying and implementing enhancement opportunities
- Able to integrate and apply feedback in a professional manner
- Able to prioritize and drive to results with a high emphasis on quality

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