Senior Director - Reimbursement

Description

MaineHealth Corporate

Management/Leadership

Req #: 31341

Summary

Works with the Vice President, Reimbursement, in departmental planning and budgeting to achieve departmental goals and supervision. Responsible for coordinating top-level review and approval for submission of Medicare, Medicaid, and other governmental payer cost reports. Develops rate structures and monitors compliance with federal and state regulatory programs. Coordinates the monitoring of implications of all proposed governmental and third-party reimbursement changes. Prepares, reviews, and approves local health system Net Patient Service Revenue Budgets. Manages internal system-level project requests, coordinating with Decision Support, Contract Management, System Development, Planning, the Central Billing Office, and Finance, both locally and system-wide. Supervises, mentors, and evaluates the effectiveness of Directors and Managers of reimbursement. Trains staff and educates leadership on higher-level reimbursement concepts and their effects on the system. Communicates revenue recognition, prior year settlements, and reimbursement changes impacting net operating revenue to local health system and corporate leadership. Ensures equitable distribution of large enrollment projects among reimbursement personnel and timely completion. Coordinates with the Vice President to ensure MaineHealth achieves optimal reimbursement under existing regulations and prepares for proposed regulation changes.

Required Minimum Knowledge, Skills, and Abilities (KSAs)

1. Education: MBA degree or HFMA or CPA certification preferred.
2. Experience: Over ten years of experience in reimbursement and Medicare/Medicaid cost reporting, with at least five years in hospital management.
3. Interpersonal Skills: High level necessary to handle complex situations with internal and external personnel and to present fact-based information to groups, including regulatory agencies.
4. Technical Knowledge: Advanced accounting and reimbursement principles, typically acquired through a Bachelor\’s degree in Accounting, Finance, Business Administration, or a related field.
5. Problem-Solving Skills: High level required to develop and implement new procedures, techniques, and prepare reports and analyses.

Additional Information

At MaineHealth, you\’ll work alongside healthcare professionals who value collaboration and community impact. We offer benefits supporting your current needs and future planning, including paid parental leave, flexible work policies, student loan assistance, training, education, and well-being resources.

MaineHealth is committed to investing in our care team and fostering an inclusive environment where you can thrive and reach your full potential. If you\’re interested in building a career where teamwork delivers top-tier care, apply today.

For questions about this role, contact Philip R. Ellis at

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