Job DescriptionThe Director of Strategic Revenue Reimbursement is a senior leader responsible for driving enterprise-wide reimbursement strategy, regulatory alignment, and revenue optimization across governmental and managed care payers. This role serves as the central point of coordination and decision support for reimbursement-related initiatives, ensuring alignment across finance, revenue cycle, compliance, legal, operations, and IT.
The Director proactively interprets regulatory changes, leads cross-functional workgroups, and ensures that reimbursement implications are fully evaluated and operationalized across the organization. This position moves beyond traditional cost reporting to a strategic, forward-looking function that maximizes reimbursement opportunities while ensuring compliance.
Responsibilities1. Strategic Leadership & Governance
- Serve as the enterprise leader and central decision-support authority for reimbursement strategy.
- Establish governance processes for evaluating new initiatives (e.g., acquisitions, new sites, service expansions).
- Lead cross-functional workgroups to ensure alignment across departments and initiatives.
- Provide recommendations to executive leadership and participate in executive and board-level discussions.
2. Regulatory Monitoring & Interpretation
- Monitor and interpret federal and state regulatory changes (e.g., CMS IPPS/OPPS rules, Medicaid policies).
- Translate regulatory updates into actionable organizational strategies.
- Lead enterprise-wide communication and implementation of regulatory changes.
- Partner with external advisors, industry groups, and advocacy organizations to stay ahead of policy developments.
3. Revenue Optimization & Financial Impact
- Identify and execute opportunities to enhance reimbursement and protect existing revenue streams.
- Lead initiatives related to:
- Wage index optimization
- Disproportionate Share Hospital (DSH) and Medicaid days strategies
- Safety net and supplemental payment programs
- Appeals and reimbursement disputes
- Provide financial modeling and forecasting for reimbursement impacts across short- and long-term horizons.
4. Cross-Functional Coordination
- Act as the hub across departments, including:
- Finance & Accounting
- Revenue Cycle
- Compliance
- Legal
- Managed Care
- IT / EHR (e.g., Epic build coordination)
- Operations
- Ensure all stakeholders are engaged early in initiative planning to prevent downstream issues.
- Eliminate siloed decision-making by driving collaborative execution.
5. Provider-Based & Structural Strategy
- Oversee evaluation and implementation of:
- Provider-based status determinations
- Site-of-service strategy
- Facility licensure and enrollment alignment
- Ensure compliance with CMS requirements (e.g., location, signage, billing, documentation).
- Coordinate with enrollment, compliance, and operational teams to ensure accurate implementation.
6. Cost Reporting & Government Reimbursement Oversight
- Provide strategic oversight of:
- Government reimbursement methodologies
- Medicare and Medicaid cost reporting
- Ensure alignment between cost reporting, operational decisions, and reimbursement strategy.
- Partner with internal teams and external consultants to optimize reporting outcomes.
7. Managed Care & Value-Based Integration
- Collaborate with managed care teams to align contract strategy with governmental reimbursement.
- Support modeling and negotiation strategies for Medicare Advantage and Medicaid MCOs.
- Partner with population health teams on value-based reimbursement and shared savings programs.
- 8. Mergers, Acquisitions & Strategic Initiatives
- Lead reimbursement strategy for acquisitions, affiliations, and expansions.
- Develop and maintain regulatory checklists and frameworks for new ventures.
- Ensure optimal structuring to preserve or enhance reimbursement (e.g., critical access, safety net status).
9. Analytics, Reporting & Executive Communication
- Develop dashboards and reporting tools to track reimbursement performance and opportunities.
- Present findings and strategic recommendations to executive leadership and board committees.
- Quantify financial impact of initiatives and track return on investment.
- 10. Team Leadership & Development
- Build and lead a high-performing reimbursement team (e.g., cost reporting, provider enrollment, analytics).
- Develop career pathways in reimbursement to attract and retain talent.
- Leverage external consultants strategically while building internal expertise.
QualificationsREQUIRED QUALIFICATIONSEXPERIENCE:- 8-12+ years of progressive experience in healthcare reimbursement, finance, or revenue cycle
Demonstrated experience with Medicare/Medicaid reimbursement methodologies and cost reporting
EDUCATION:- Bachelor's degree in Accounting, Finance, Healthcare Administration, or related field (required)
Knowledge & Expertise- Deep understanding of:
- CMS regulations (IPPS, OPPS, provider-based rules)
- Medicare and Medicaid reimbursement models
- Cost reporting and governmental payment structures
- Experience with:
- Revenue optimization strategies
- Regulatory interpretation and implementation
- Cross-functional leadership in complex healthcare systems
Leadership Competencies- Strategic thinker with ability to connect operational decisions to financial outcomes
- Strong collaborator with ability to influence across departments
- Proven ability to lead through ambiguity and organizational change
- Executive presence with strong communication and presentation skills
PREFERRED QUALIFICATIONSEDUCATION:- Master's degree (MBA, MHA) or CPA (preferred)
