Senior Director, System Reimbursement

This is a fully remote position, open to applicants in Pennsylvania.

📋 Description

• Provides strategic and operational leadership across the enterprise for reimbursement and patient service revenue recognition, ensuring compliance with regulatory standards.

• Guarantees the integrity, completeness, and accuracy of net patient service revenue, along with third-party settlement estimates, following GAAP principles.

• Supervises methodologies that support financial estimations while continuously monitoring variances, conducting hindsight analysis, and identifying emerging trends.

• Leads the creation of advanced analytics and tools (e.g., dashboards, predictive models) that deliver actionable insights into reimbursement trends, denial drivers, and the financial implications of value-based and quality reimbursement programs.

• Actively tracks and interprets changing federal and state reimbursement regulations and payer methodologies, translating these changes into actionable strategies to ensure full regulatory compliance.

• Distills complex regulatory changes and reimbursement dynamics into clear insights for executives, including quantified financial impacts, risks, and recommended strategic actions for senior leadership and governance committees.

• Oversees the prompt and accurate preparation and submission of all third-party cost reports and other reimbursement-related reports required by third-party payors and/or government agencies.

• Manages all interactions with Medicare Administrative Contractors and other payors, including audit management, settlement reviews, and appeal strategies to achieve optimal financial results and defensible positions.

• Directs the research and collection of data necessary for filing formal appeals, re-opening requests, and exception requests related to rates or payment methodologies to support Geisinger's stance on governmental and third-party regulations.

• Ensures adherence to all relevant federal and state reimbursement regulations, including CMS rules, Medicare/Medicaid payment methodologies, and related billing and documentation requirements across hospital, professional, and academic entities.

• Offers strategic and technical guidance on graduate medical education reimbursement, encompassing modeling, affiliation agreements, and compliance with CMS resident cap regulations.

• Acts as a strategic advisor in assessing proposed regulatory and legislative changes, collaborating with Government Relations to influence policy through data-driven analyses, formal comment letters, and industry engagement.

• Builds and cultivates a high-performing team through strategic talent management, succession planning, and fostering a culture of accountability, continuous improvement, and cross-functional collaboration.

• Advocates for the adoption and enhancement of reimbursement and revenue analytics technologies, including automation tools and advanced modeling platforms, to boost accuracy, efficiency, and scalability.

• Provides subject matter expertise on reimbursement and revenue recognition implications for mergers, acquisitions, affiliations, and new business models, including due diligence, integration planning, and pro forma financial impact analysis.

⛳️ Requirements

• Bachelor's Degree - (Required)

• Master's Degree - (Preferred)

• Minimum of 8 years in Finance - (Required)

• Minimum of 5 years in Managerial/Supervisory roles - (Required)

• Skills: Analytical Thinking, Communication, Computer Literacy, Healthcare Industry Knowledge, Organization, Teamwork

🏝️ Benefits

• Healthcare benefits for both full-time and part-time positions starting from day one, including vision, dental, and domestic partner coverage.

• An environment that fosters collaboration, cooperation, and collegiality.