Director of Reimbursement and Payor Analysis

Summary:

Responsibilities:

1. Oversee and analyze governmental and commercial payor reimbursement, ensuring accuracy and optimization.

2. Lead the preparation and submission of CMS and Medicaid cost reports, ensuring compliance with regulatory requirements.

3. Develop and maintain charge master pricing strategies aligned with market trends and hospital financial objectives.

4. Assist payor strategy with negotiation of contracts through modeling financial implications of proposals.

5. Provide reimbursement modeling and strategic analysis of reimbursement trends, identifying opportunities to enhance financial performance.

6. Support advocacy efforts through modeling impacts to Medicaid supplemental programs and other proposed legislative changes.

7. Supervise and mentor a team of analysts, ensuring accurate interpretation of reimbursement data and trends.

8. Communicate key reimbursement insights and financial impacts to senior leadership and operational teams.

9. Ensure compliance with regulatory requirements and interact with external agencies such as CMS, state Medicaid agencies, and commercial payors.

10. Participate in hospital finance reviews and contribute to long-term financial planning and strategy.

11. Collaborate with the Revenue Cycle team to enhance reimbursement accuracy and optimize financial outcomes.

12. Estimate and record monthly contractual adjustments on accounts receivable, supporting the monthly close process.

13. Stay current with industry changes, regulatory updates, and reimbursement methodologies to guide hospital strategy.

Other information:

Technical Expertise:

1. Analytical Skills: Excellent analytical and problem-solving abilities to assess financial data and develop effective reimbursement strategies.

2. Communication Skills: Strong communication and negotiation skills to interact effectively with payers, staff, and other stakeholders.

3. Technical Proficiency: Experience with electronic health record (EHR) systems and familiarity with healthcare billing software.

Education and Experience:

1. Education: A bachelor's degree in accounting, finance, healthcare administration, business administration, or a related field is required; a master's degree is preferred.

2. Certification: Relevant certifications such as Certified Specialist Payment and Reimbursement (CSPR) or Certified Cost Report Specialist (CHCRS) are advantageous.

3. Years of experience: at least 7 years in healthcare reimbursement, with a strong understanding of Medicare and Medicaid reimbursement strategies/programs and payor contracting.

4. Years of supervision at least 3 years.

Full Time

FTE: 1.000000

Status: Onsite