Senior Director, System Reimbursement

🕒 Junho 24

🔔 Pennsylvania – Remoto

🔔 Pennsylvania – Remote

⏰ Tempo Integral

🟠 Sênior

👔 Diretor

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Geisinger

SiteLinkedInTodas as Vagas

10.000+ funcionários

Fundada em 1915

🏥 Saúde

💊 Farmacêutico

🧘 Bem-estar

Healthcare • Pharmaceuticals • Wellness

Geisinger é uma organização de saúde que atende comunidades na Pensilvânia há mais de um século, oferecendo serviços médicos essenciais e soluções inovadoras em saúde. A organização enfatiza a diversidade, o desenvolvimento de carreira e a criação de um ambiente de apoio para seus funcionários, enquanto se esforça para melhorar a saúde e o bem-estar de seus pacientes por meio de diversos programas e iniciativas comunitárias. Geisinger é reconhecida como um dos sistemas de saúde mais inovadores e está comprometida em moldar o futuro da saúde com foco no cuidado ao paciente e na inclusividade.

Descrição

• Provides enterprise-wide strategic and operational leadership for reimbursement and patient service revenue recognition ensuring alignment with regulatory requirements • Ensures the integrity, completeness, and accuracy of net patient service revenue, and third-party settlement estimates, in accordance with GAAP • Oversees methodologies supporting financial estimates and continuously monitors variance, hindsight analysis, and emerging trends • Leads the development of advanced analytics and tools (e.g., dashboards, predictive models) that provide actionable insights into reimbursement trends, denial drivers, and the financial impact of value-based and quality reimbursement programs • Proactively monitors and interprets evolving federal and state reimbursement regulations and payer methodologies, translating changes into actionable strategies that maintain full regulatory compliance • Synthesizes complex regulatory changes and reimbursement dynamics into clear, executive-level insights, including quantified financial impacts, risks, and recommended strategic responses for senior leadership and governance committees • Oversees the timely and accurate completion and submission of all third-party cost reports and other reimbursement reports or correspondence which may be required by third-party payors and/or government agencies • Oversees all interactions with Medicare Administrative Contractors and other payors, including audit management, settlement reviews, and appeal strategies, ensuring optimal financial outcomes and defensible positions • Directs the research and accumulation of data for filing of formal appeals, re-opening requests, exception requests to rates or payment methodologies to support the Geisinger's position on governmental and third-party regulations • Ensures compliance with all applicable federal and state reimbursement regulations, including CMS rules, Medicare/Medicaid payment methodologies, and related billing and documentation requirements across hospital, professional, and academic entities • Provides strategic and technical guidance on graduate medical education reimbursement, including modeling, affiliation agreements, and compliance with CMS resident cap regulations • Serves as a strategic advisor in evaluating proposed regulatory and legislative changes, partnering with Government Relations to influence policy through data-driven analysis, formal comment letters, and industry engagement • Builds and develops a high-performing team through strategic talent management, succession planning, and a culture of accountability, continuous improvement, and cross-functional collaboration • Champions the adoption and optimization of reimbursement and revenue analytics technologies, including automation tools and advanced modeling platforms, to improve accuracy, efficiency, and scalability • Provides subject matter expertise on reimbursement and revenue recognition implications for mergers, acquisitions, affiliations, and new business models, including due diligence, integration planning, and pro forma financial impact analysis

🎯 Requisitos

• Bachelor's Degree- (Required) • Master's Degree- (Preferred) • Minimum of 8 years-Finance (Required) • Minimum of 5 years-Managerial/Supervisory (Required) • Skills: Analytical Thinking, Communication, Computer Literacy, Healthcare Industry, Organizing, Teamwork

🏖️ Benefícios

• healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners • atmosphere of collaboration, cooperation and collegiality