Overview

 

 

The Director, Insurance & Reimbursement is responsible for providing strategic leadership and operational oversight for Oticon Medical's U.S. Insurance & Reimbursement organization. This position is accountable for developing and executing reimbursement strategies that maximize patient access, improve revenue realization, strengthen payer relationships, and deliver an exceptional customer experience.

 

The Director leads all aspects of reimbursement operations, including insurance verification, prior authorizations, credentialing, claims management, appeals, collections support, payer contracting, and reimbursement policy. Working cross-functionally with Sales, Customer Service, Finance, Clinical, Marketing, Regulatory Affairs, External Parties/Consultant Relationships, and Executive Leadership, this individual develops scalable processes that improve operational efficiency while supporting the company's commercial objectives.

 

The Director is expected to build and lead a high-performing organization that combines operational excellence with strategic thinking, ensuring Oticon Medical remains a trusted partner for providers, patients, and payers.

Responsibilities Strategic Leadership

• Develop and execute the Company's U.S. Insurance & Reimbursement strategy.
• Establish departmental goals, key performance indicators (KPIs), and operational metrics.
• Build an organization capable of supporting future business growth and product expansion.
• Extensive management of external parties/consultant relationships, including credentialing and billing.
• Develop annual operating plans and departmental budgets.
• Provide strategic recommendations to executive leadership regarding reimbursement opportunities and risks.
• Foster a culture of accountability, continuous improvement, collaboration, and customer focus.

Insurance & Reimbursement Operations

• Direct all insurance verification, benefits investigations, prior authorizations, claims submission, appeals, and reimbursement activities.
• Oversee denial management processes and implement strategies that improve approval rates and reimbursement outcomes.
• Establish service level expectations and performance standards for all reimbursement functions.
• Monitor reimbursement performance through key operational metrics and implement corrective actions when necessary.
• Ensure timely and accurate processing of all reimbursement-related activities.
• Drive improvements that reduce reimbursement cycle times and increase collection performance.

Credentialing & Market Access

• Lead Medicare, Medicaid, VA, and commercial payer credentialing initiatives.
• Develop strategies to expand payer participation and improve patient access. Provide clear and strategic guidance and prioritization to external parties/consultants.
• Provide clear and strategic guidance and prioritization to external parties/consultants.
• Maintain relationships with commercial insurers, government agencies, and third-party administrators.
• Monitor changes in reimbursement policies, coverage determinations, and healthcare regulations.
• Evaluate reimbursement implications associated with new products and market opportunities.

Revenue Cycle & Financial Performance

• Partner with Finance to improve reimbursement collections and reduce outstanding insurance receivables.
• Monitor reimbursement trends and identify opportunities to improve financial performance.
• Develop reporting tools that provide visibility into reimbursement performance, denials, appeals, collections, and payer activity.
• Recommend operational improvements that positively impact revenue realization.

Cross-Functional Leadership

• Partner with Sales to remove reimbursement barriers affecting customer adoption.
• Collaborate with Customer Service to deliver a seamless customer experience.
• Support Marketing with reimbursement messaging, educational materials, and product launches.
• Work closely with Clinical, Regulatory Affairs, and Quality to ensure reimbursement strategies align with regulatory requirements and clinical evidence.
• Support Executive Leadership with reimbursement analysis and strategic planning.

Process Improvement & Compliance

• Develop, implement, and maintain departmental policies, procedures, and quality standards.
• Identify opportunities to improve workflow efficiency through automation and technology.
• Ensure compliance with all federal, state, payer, and company policies.
• Maintain appropriate documentation, audit readiness, and quality assurance processes.
• Promote continuous improvement initiatives across the department.

Leadership & Talent Development

• Recruit, hire, develop, and retain high-performing team members.
• Establish clear performance expectations and accountability measures.
• Provide coaching, mentoring, and professional development opportunities.
• Conduct performance evaluations and succession planning.
• Promote a positive, collaborative, and customer-focused culture.

Qualifications Required

• Bachelor's degree in Business, Healthcare Administration, Finance, or related field.
• Minimum of 10 years of progressive leadership experience in healthcare insurance, reimbursement, revenue cycle, or payer operations.
• Minimum of 5 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 processing, appeals, denial management, and reimbursement optimization.
• Demonstrated success leading organizational change and process improvement initiatives.
• Experience developing departmental budgets and managing financial performance.
• Strong analytical, organizational, and problem-solving skills.
• Excellent written, verbal, and presentation skills.
• Ability to influence and collaborate across multiple functional areas.

Preferred

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

Core Competencies

• Strategic Leadership
• Customer Focus
• Financial Acumen
• Business Planning
• Cross-Functional Collaboration
• Change Management
• Operational Excellence
• Process Improvement
• Decision Making
• Communication & Influence
• Team Development
• Accountability
• Integrity
• Continuous Learning

Introductory or Probationary Period

• The first 180 calendar days of employment are considered an introductory or probationary employment period. During this time, the employee will receive training, coaching, and ongoing performance feedback while demonstrating the ability to successfully perform the essential duties of the position and meet the Company's performance expectations.
• Failure to successfully complete the 180-day introductory employment period, including demonstrating satisfactory performance, competency, conduct, and adherence to Company policies and performance expectations, may result in termination of employment. Successful completion of the introductory period does not alter the at-will nature of employment or guarantee continued employment.

 

What we have to offer:Medical, dental, prescription, and vision benefits24/7 virtual medical careEmployee Assistance Program for you and your family401(k) with company matchCompany-paid life insuranceSupplemental insurance for yourself, your spouse/partner, and your childrenShort-term and long-term disability insurancePre-tax Health Savings Account and Flexible Spending Accounts for Health Care or Dependent CarePet InsuranceCommuter accounts  The pay range for this position is expected to be between $130000 to $145000 per year; however, while the salary range is effective as of the date of this posting, fluctuations in the job market may necessitate adjustments to pay ranges. Further, final pay determinations will depend on various factors, including but not limited to experience level, knowledge, skills, and abilities. The total compensation package for this position may also include other elements, such as bonus, commissions, or discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered. Details of participation in these benefit plans will be provided if an employee receives an offer of employment.  

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