Director, Reimbursement - Health System Reimbursement - hybrid role (#1 Hospital in CA)

Job Description

The Director of Reimbursement provides leadership, management, and coordination of government reimbursement for multiple hospitals within the health system. This role ensures timely and accurate financial and governmental reporting by managing the reimbursement team consistent with regulatory guidelines. The Director is responsible for identifying, developing, and implementing comprehensive strategies, policies, and procedures that optimize all aspects of reimbursement management. The role requires vigilant monitoring of state and federal regulatory proposals related to healthcare payment policies, with the ability to perform impact assessments and effectively communicate findings to executive leadership. Additionally, the Director is dedicated to fostering staff development, enhancing productivity, and driving performance improvements while adhering to department budgets.

• Provides strategic leadership, management, and coordination for government reimbursement across multiple hospitals within the health system.
• Ensures timely and accurate completion of financial reporting by effectively managing the reimbursement team in accordance with relevant regulatory and policy guidelines. This includes overseeing multiple filing requirements including state, federal and private industry reporting (Medicare, Medi-Cal, HCAI, NIH, AHA, etc.).
• Monitors and communicates federal and state regulatory proposals regarding healthcare reimbursement and provides effective briefings and impact assessments as needed for multiple constituent groups including executive management.
• Coordinates with consultants and both internal and external counsel concerning regulatory appeals, special projects, and other reporting matters at the health system level.
• Manages audit responses and provides guidance as needed for all relevant external and internal audit reviews, including those conducted by Medicare, Medi-Cal, National Institutes of Health (NIH), Office of Inspector General (OIG), and other agencies, as well as the health system's annual financial audit.
• Prepares annual reporting for the National Institutes of Health regarding research funding for indirect rate and fringe benefit reimbursement.
• Identifies and implements strategies, policies, and procedures related to all aspects of reimbursement management.
• Ensures compliance with all applicable state and federal regulatory guidelines related to financial reporting.
• Manages the productivity, development, and performance of the reimbursement team, ensuring adherence to budget targets and maintaining compliance with all applicable internal policies and procedures.

Qualifications

Education:

Bachelor's degree - minimum - Finance, accounting, or other relevant field with appropriate combination of education and experience.

Work Experience:

3 years - minimum - Leadership experience with Medicare and Medicaid (Medi-Cal) reimbursement showing leadership progression within a relevant organization.

5 years - preferred - Leadership experience with Medicare and Medicaid (Medi-Cal) reimbursement in a large academic medical center or health system environment.

This hybrid role requires a minimum of two days per week in the office.