Summary:The Director, Healthcare Finance & Reimbursement is responsible for leading the day-to-day operations of the healthcare finance and reimbursement function, with a strong hands-on focus on reimbursement analysis, cost reporting oversight, regulatory compliance, and financial support. This role provides both technical expertise and functional leadership while partnering with internal stakeholders to support accurate reimbursement, sound financial analysis, and effective department operations. The Director also supports team development, process improvement, and high-quality service delivery.
Duties and Responsibilities:- Lead the day-to-day activities of the healthcare finance and reimbursement function, providing hands-on leadership, technical guidance, work direction, and support for team performance and development.
- Establish priorities, monitor deliverables, improve workflows, and promote accountability to ensure timely, accurate, and high-quality service delivery.
- Develop and execute reimbursement strategies for Medicare, Medicaid, and commercial payers while overseeing reimbursement analysis related to payment methodologies, reimbursement trends, settlement activity, service line performance, contractual accounting, and bad debt reserves.
- Review cost reports prepared by internal staff or outside parties and ensure timely, accurate completion of interim and final cost reports.
- Direct and perform financial modeling and variance analysis related to reimbursement structures, payment trends, and revenue optimization opportunities.
- Prepare and present financial reports, insights, and recommendations to finance leadership and other internal stakeholders to support informed decision-making.
- Ensure compliance with CMS guidelines and other applicable federal and state reimbursement regulations by monitoring regulatory changes, evaluating payment model impacts, and supporting organizational readiness.
- Lead and support internal and external audits related to reimbursement, cost reporting, and payment practices, while maintaining current knowledge of value-based care models and alternative payment methodologies.
- Partner with finance, operations, and other internal stakeholders to resolve issues, strengthen processes, and support compliance across reimbursement-related activities.
Work Experience, Education, and Certifications:- Bachelor's degree in finance, Accounting, Healthcare Administration, or related field required. Master's preferred
- Minimum of 7 years of progressive experience in healthcare finance, reimbursement, or related areas.
- Strong experience with Medicare hospital cost reports required.
- Prior leadership or supervisory experience preferred.
Knowledge, Skills, and Abilities:- Advanced proficiency in Excel and financial modeling required.
- Deep understanding of Medicare, Medicaid, DRG/APC payment systems, and managed care contracts
- Strong financial modeling and data analysis skills
- Knowledge of value-based care, bundled payments, and risk-based contracts
- Excellent communication and stakeholder management skills
- Experience with healthcare financial systems and reimbursement reporting tools preferred.
- Familiarity with data visualization and reporting tools such as Tableau or Power BI preferred.
