Director – Reimbursement

🌍 Remote, USA 🎯 Full-time 🕐 Posted Recently

Job Description

Ensure timely and accurate filing of annual government cost reports, including Medicare, Medi-Cal, and HCAI submissions.
Maintain comprehensive knowledge of federal and state reimbursement laws and regulations to maximize reimbursement.
Develop, implement, and maintain internal policies and procedures to ensure complete and accurate capture of all legitimate reimbursement opportunities.
Oversee Medicare and Medi-Cal audit processes, addressing inquiries and pursuing appeals or litigation when necessary (e.g., CMS disputes).
Review third-party contractual allowances, settlements, and variances (actual vs. budget) to support accurate financial reporting.
Participate in the annual budget development process by providing detailed analysis and projections related to government payor net income.
Prepare and respond to year-end financial audits, specifically related to third-party liabilities and balance sheet reserves.
Serve as the subject matter expert on regulatory compliance reporting, including Medicare and Medi-Cal cost reports
Lead alignment of compliance reporting processes across SHC-related entities and partner organizations.
Continuously assess and improve reimbursement and reporting processes to increase efficiency, accuracy, and scalability.
Oversee invoicing, contract compliance, and financial administration for non-patient care service agreements, such as Graduate Medical Education (GME) affiliation agreements and Physician outreach and other academic/clinical support contracts.
Coordinate with internal department, affiliated entities, and external partners to ensure contract terms are accurately maintained and executed.
Ensure obligations are properly managed and tracked within the Workday customer management model.
Serve as the subject matter expert for the Workday customer management model, assisting in the development and enhancement of business process workflows.
Participate in system testing and user acceptance activities related to workflow improvements and updates within Workday.
Promote a culture of learning, continuous improvement, and compliance across the reimbursement function.
Mentor and develop staff to deepen their knowledge of reimbursement regulations, reporting, and methodologies.
Support talent development and succession planning by identifying growth opportunities and preparing high-potential staff for future leadership roles.
Work cross-functionally with leaders and staff from various departments and backgrounds to address complex reimbursement and compliance matters.
Communicate complex, variable reimbursement and regulatory issues in clear, concise narratives to support strategic decision-making.
Provide analytical and subject matter support to broader strategic and financial initiatives as needed.

Bachelor’s Degree in business, finance, health or public administration or a related field
Master’s Degree in business, health or public administration, management, or related field strongly preferred
Minimum ten (10) years of progressively responsible and directly related work experience required
Preferred experience as an auditor working with CMS or a CMS Medicare Auditor Contractor and strong familiarity with Medicare and Medicaid regulations.
Advanced knowledge of CMS and state Medicaid reimbursement principles and practices.
Multi-year skill and experience managing business processes for organizations using a major ERP system.
Ability to communicate complex concepts in simple form to non-finance users to understand the appropriate use and limits of the information provided.
Ability to communicate and present complex issue with government agencies to resolve audit issues.
Ability to manage, organize, prioritize, multi-task and adapt to changing priorities.
Ability to foster effective working relationships and build consensus.
Ability to partner in the development and achievement of goals, vision, and overall direction of the Controller’s Office at Stanford Health Care.
Ability to provide clear and concise information/presentations to Senior Executive Team.
Ability to develop strong team culture and working relationship with colleagues across the health system.
Ability to drive a culture of proactive, integrated, responsive, high quality financial analysis.
Ability to effectively manage deliverables and timelines.