System Director, Reimbursement

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

📋 Description

• Lead the reimbursement operating model for the designated state portfolio and markets.

• Supervise cost reporting, Medicare and Medicaid payment integrity, regulatory analysis, audits, settlements, and strategic advisory initiatives.

• Implement enterprise reimbursement standards and manage approved adaptations specific to each state.

• Direct a team of Directors, Managers, Senior Analysts, technical leaders, and matrixed GBS support.

• Establish priorities, allocate resources, and maintain plans for succession and contingencies.

• Monitor and model CMS regulations, state Medicaid rate adjustments, and legislative changes.

• Maintain regulatory calendars and provide financial impact assessments to the VP of Reimbursement and market CFOs.

• Oversee monitoring of cost reports, reconciliations, reimbursement strategies, and quarterly CFO updates.

• Manage the Medicare and Medicaid cost report lifecycle, including filing deadlines, audits, NPRs, reopenings, and appeals.

• Lead efforts in Medicare and Medicaid fee-for-service payment integrity, covering audit risk monitoring, self-audits, overpayment identification, repayment governance, and compliance oversight.

• Maintain reimbursement forecasting and risk reporting for the assigned state portfolio.

• Deliver executive reports on forecasts, settlements, filing statuses, audit risks, regulatory changes, resource risks, controls, and corrective measures.

• Act as the reimbursement subject matter expert for Revenue Cycle analyses, denial strategies, and related projects.

• Utilize reimbursement expertise across various settings including acute, post-acute, ambulatory, physician, behavioral health, and specialty care.

• Serve as the primary reimbursement contact for state presidents, state Finance leaders, and market executives.

• Provide guidance on service line development, acquisition due diligence, site-of-care strategies, new programs, and capital project financial projections.

• Advocate for AI, GenAI, data science, automation, and digital upskilling in reimbursement analytics and reporting.

• Oversee the execution of stateside GBS operations, work segmentation, quality standards, acceptance criteria, and escalation processes.

• Strengthen internal controls, quality assurance, reconciliations, management reviews, and remediation governance.

• Develop performance-management frameworks and support enhancements in technology, analytics, workflow, and automation.

⛳️ Requirements

• Bachelor's degree in accounting, finance, business administration, health care administration, or a related field, or an equivalent combination of education and relevant experience.

• Significant progressive experience in hospital reimbursement, including leadership responsibility for Medicare and Medicaid cost reporting, settlements, regulatory analysis, audits, and complex reimbursement issues in a multi-entity environment.

• Proven experience with intricate Medicare and Medicaid reimbursement issues, including cost reporting, payment integrity oversight, regulatory analysis, audits, appeals, reserves, or related reimbursement analytics.

• Familiarity with hospital reimbursement across diverse care settings, including acute, post-acute, ambulatory, and/or physician environments.

• Demonstrated capability to lead leaders and manage extensive assigned portfolios with competing regulatory deadlines, specialized reimbursement matters, and significant financial exposure.

• Proven ability to advise senior executives and CFOs, synthesize complex issues, and present clear recommendations and necessary decisions.

• Experience in establishing enterprise internal controls, QA governance, standardized processes, performance metrics, and audit-ready documentation.

• Foundational digital literacy, including familiarity with AI and GenAI tools, prompt engineering, use-case identification, and the ability to interpret, validate, and explain AI-generated analytical outputs.

• Capacity to identify algorithmic bias and apply critical thinking to technology-generated results before their application in regulatory or executive contexts.

• Experience leading matrixed, shared-services, or geographically dispersed teams and fostering accountability across organizational boundaries (preferred).

• Familiarity with state Medicaid programs, state-specific supplemental payment structures, and state Medicaid managed care organizations relevant to BSMH's operating states (Ohio, Virginia, Kentucky, South Carolina, Maryland) (preferred).

• Master's degree in accounting, finance, business administration, or health care administration (preferred).

• CPA, FHFMA, CRCR, or other advanced professional credentials (preferred).

• Leadership experience within a large multi-state health system (preferred).

• Experience overseeing a global business services or offshore operating model in a reimbursement, finance, or revenue cycle context (preferred).

• Experience in managing reimbursement technology, workflow, data governance, analytics, or automation initiatives (preferred).

• Experience with substantial Medicare and Medicaid audits, appeals, regulatory strategies, and executive financial reporting (preferred).

• Experience collaborating with Legal, Compliance, Pharmacy/340B, Revenue Cycle, or operational teams on government payer audits, overpayments, disclosures, or payment risk issues (preferred).

• Experience with Medicare and Medicaid payment integrity programs, including RAC defense, OIG self-disclosures, PERM/CERT exposure modeling, and 340B compliance (preferred).

• Proficiency in digital talent using low-code or no-code tools, Python-based analytics libraries (NumPy, Pandas, Matplotlib), or similar platforms (preferred).

• Experience in designing, governing, or overseeing AI/ML or agentic AI workflows within finance, reimbursement, or revenue cycle contexts (preferred).

• Proven ability to promote digital upskilling within a team, developing tiered AI and data science capabilities (preferred).

🏝️ Benefits

• Competitive pay.

• Incentives.

• Referral bonuses.

• 403(b) with employer contributions (when eligible).

• Medical, dental, vision, and prescription coverage.

• HSA/FSA options.

• Life insurance.

• Mental health resources and discounts.

• Paid time off.

• Parental and FMLA leave.

• Short- and long-term disability.

• Backup care for children and elderly individuals.

• Tuition assistance.

• Professional development.

• Continuing education support.