System Director, Reimbursement

🔥 16 hours ago

🇺🇸 United States – Remote

⏰ Full Time

🔴 Lead

👔 Director

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Bon Secours Mercy Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 2018

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

Bon Secours Mercy Health is a leading health care organization committed to transforming health care delivery and services through strategic innovation and compassionate care. Operating hospitals and clinical sites in the U. S. and Ireland, the organization focuses on extending health care access, improving patient outcomes, and enhancing value through emerging technologies and strategic partnerships. With a commitment to service and stewardship, Bon Secours Mercy Health also prioritizes enhancing the quality of life for underserved communities while advocating for sustainability. The organization’s initiatives include digital innovation, diversified growth through investments and partnerships, and providing high-value care across its core clinical operations.

📋 Description

• Lead the reimbursement operating model for the assigned state portfolio and markets • Oversee cost reporting, Medicare and Medicaid payment integrity, regulatory analysis, audits, settlements, and strategic advisory activities • Apply enterprise reimbursement standards and coordinate approved state-specific adaptations • Direct Directors, Managers, Senior Analysts, technical leaders, and matrixed GBS support • Set priorities, allocate resources, and maintain succession and contingency plans • Monitor and model CMS rules, state Medicaid rate changes, and legislative developments • Maintain regulatory calendars and provide financial impact analysis to the VP, Reimbursement and market CFOs • Oversee cost report monitoring, reconciliations, reimbursement positioning, and quarterly CFO reporting • Govern the Medicare and Medicaid cost report lifecycle, filing deadlines, audits, NPRs, reopenings, and appeals • Lead Medicare and Medicaid fee-for-service payment integrity, including audit risk monitoring, self-audits, overpayment identification, repayment governance, and compliance monitoring • Maintain reimbursement forecasting and risk reporting across the assigned state portfolio • Provide executive reporting on forecasts, settlements, filing status, audit exposure, regulatory change, resource risks, controls, and corrective actions • Serve as reimbursement subject matter expert for Revenue Cycle analyses, denial strategies, and projects • Apply reimbursement expertise across acute, post-acute, ambulatory, physician, behavioral health, and specialty settings • Serve as primary reimbursement contact for state presidents, state Finance leadership, and market leaders • Advise on service line development, acquisition due diligence, site-of-care strategy, new programs, and capital project pro formas • Champion AI, GenAI, data science, automation, and digital upskilling for reimbursement analytics and reporting • Oversee stateside-GBS execution, work segmentation, quality standards, acceptance criteria, and escalations • Strengthen internal controls, quality assurance, reconciliations, management reviews, and remediation governance • Build performance-management frameworks and sponsor technology, analytics, workflow, and automation improvements

🎯 Requirements

• Bachelor's degree in accounting, finance, business administration, health care administration, or a related field, or an equivalent combination of education and directly relevant experience • Extensive progressive hospital reimbursement experience, including leadership accountability for Medicare and Medicaid cost reporting, settlements, regulatory analysis, audits, and complex reimbursement matters in a multi-entity environment • Demonstrated experience with complex Medicare and Medicaid reimbursement matters, including cost reporting, payment integrity oversight, regulatory analysis, audits, appeals, reserves, or related reimbursement analytics • Working knowledge of hospital reimbursement across multiple care settings, including acute, post-acute, ambulatory, and/or physician settings • Demonstrated experience leading leaders and managing broad assigned portfolios with competing regulatory deadlines, specialized reimbursement matters, and material financial exposure • Demonstrated ability to advise senior executives and CFOs, synthesize complex issues, and present clear recommendations and decisions needed • Demonstrated experience establishing enterprise internal controls, QA governance, standardized processes, performance measures, and audit-ready documentation • Foundational digital literacy, including working familiarity with AI and GenAI tools, prompt engineering, use-case identification, and the ability to interpret, validate, and explain AI-generated analytical outputs • Ability to identify algorithmic bias and apply critical thinking to technology-produced results before use in regulatory or executive contexts • Experience leading matrixed, shared-services, or geographically distributed teams and driving accountability across organizational boundaries (preferred) • Experience with state Medicaid programs, state-specific supplemental payment structures, and state Medicaid managed care organizations relevant to BSMH's operating states (Ohio, Virginia, Kentucky, South Carolina, Maryland) (preferred) • Master's degree in accounting, finance, business administration, or health care administration (preferred) • CPA, FHFMA, CRCR, or other advanced professional credential (preferred) • Leadership experience in a large multi-state health system (preferred) • Experience governing a global business services or offshore operating model in a reimbursement, finance, or revenue cycle context (preferred) • Experience leading reimbursement technology, workflow, data governance, analytics, or automation initiatives (preferred) • Experience with significant Medicare and Medicaid audits, appeals, regulatory strategy, and executive financial reporting (preferred) • Experience partnering with Legal, Compliance, Pharmacy/340B, Revenue Cycle, or operational teams on government payer audit, overpayment, disclosure, or payment risk matters (preferred) • Experience with Medicare and Medicaid payment integrity programs, including RAC defense, OIG self-disclosures, PERM/CERT exposure modeling, and 340B compliance (preferred) • Citizen digital talent proficiency using low-code or no-code tools, Python-based analytics libraries (NumPy, Pandas, Matplotlib), or similar platforms (preferred) • Experience designing, governing, or overseeing AI/ML or agentic AI workflows in a finance, reimbursement, or revenue cycle context (preferred) • Demonstrated ability to drive digital upskilling across a team, building tiered AI and data science capability (preferred)

🏖️ Benefits

• Competitive pay • Incentives • Referral bonuses • 403(b) with employer contributions (when eligible) • Medical, dental, vision, and prescription coverage • HSA/FSA options • Life insurance • Mental health resources and discounts • Paid time off • Parental and FMLA leave • Short- and long-term disability • Backup care for children and elders • Tuition assistance • Professional development • Continuing education support