Director, Insurance & Reimbursement

Role overview

Strategic leadership and operations

• Set reimbursement strategy, departmental goals, KPIs, operating plans, and budgets; advise executive leadership on opportunities and risks.
• Direct verification, benefits investigations, prior authorizations, claims, appeals, denial management, and reimbursement operations.
• Improve service standards, processing timeliness, cycle times, collections, and reimbursement outcomes.
• Manage external parties and consultants, including credentialing and billing relationships.

Payer access and financial performance

• Lead Medicare, Medicaid, VA, and commercial payer credentialing and expand payer participation and patient access.
• Maintain payer and government relationships; monitor reimbursement policies, coverage determinations, and healthcare regulations.
• Evaluate reimbursement effects of new products and market opportunities.
• Partner with Finance to improve collections and reduce outstanding insurance receivables; develop reporting on performance, denials, appeals, collections, and payer activity.

Cross-functional leadership and compliance

• Partner with Sales, Customer Service, Marketing, Clinical, Regulatory Affairs, Quality, and executive leadership on customer adoption, product launches, compliance, and planning.
• Maintain departmental policies, procedures, quality standards, compliance, documentation, audit readiness, and process improvement.
• Recruit, hire, coach, develop, evaluate, and retain high-performing team members; promote accountability and collaboration.

Required qualifications

• Bachelor's degree in business, healthcare administration, finance, or a related field.
• At least 10 years of progressive leadership experience in healthcare insurance, reimbursement, revenue cycle, or payer operations, including at least five years leading high-performing teams.
• Extensive knowledge of Medicare, Medicaid, commercial insurance, VA, and managed care reimbursement.
• Experience with provider credentialing and payer enrollment; strong understanding of claims, appeals, denial management, and reimbursement optimization.
• Demonstrated success leading organizational change and process improvement; experience with departmental budgets and financial performance.
• Strong analytical, organizational, and problem-solving skills; excellent written, verbal, and presentation skills; ability to influence and collaborate across functions.

Preferred qualifications

• Medical device, hearing healthcare, ENT, audiology, DMEPOS, or implantable medical technology experience.
• Knowledge of reimbursement regulations and payer policy development; Lean, Six Sigma, or continuous improvement certification; MBA, MHA, or other advanced degree.

Compensation

• Expected pay range is $130,000–$145,000 per year; additional compensation may include bonuses, commissions, or discretionary awards.

Benefits

• Benefits include medical, dental, prescription, and vision coverage; virtual medical care; an employee assistance program; 401(k) match; life and disability insurance; savings and commuter accounts; and pet insurance.

Introductory period