Director – Reimbursement

Job Description:

• Ensure timely and accurate filing of annual government cost reports, including Medicare, Medi-Cal, and HCAI submissions.
• Maintain comprehensive knowledge of federal and state reimbursement laws and regulations to maximize reimbursement.
• Develop, implement, and maintain internal policies and procedures to ensure complete and accurate capture of all legitimate reimbursement opportunities.
• Oversee Medicare and Medi-Cal audit processes, addressing inquiries and pursuing appeals or litigation when necessary (e.g., CMS disputes).
• Review third-party contractual allowances, settlements, and variances (actual vs. budget) to support accurate financial reporting.
• Participate in the annual budget development process by providing detailed analysis and projections related to government payor net income.
• Prepare and respond to year-end financial audits, specifically related to third-party liabilities and balance sheet reserves.
• Serve as the subject matter expert on regulatory compliance reporting, including Medicare and Medi-Cal cost reports
• Lead alignment of compliance reporting processes across SHC-related entities and partner organizations.
• Continuously assess and improve reimbursement and reporting processes to increase efficiency, accuracy, and scalability.
• Oversee invoicing, contract compliance, and financial administration for non-patient care service agreements, such as Graduate Medical Education (GME) affiliation agreements and Physician outreach and other academic/clinical support contracts.
• Coordinate with internal department, affiliated entities, and external partners to ensure contract terms are accurately maintained and executed.
• Ensure obligations are properly managed and tracked within the Workday customer management model.
• Serve as the subject matter expert for the Workday customer management model, assisting in the development and enhancement of business process workflows.
• Participate in system testing and user acceptance activities related to workflow improvements and updates within Workday.
• Promote a culture of learning, continuous improvement, and compliance across the reimbursement function.
• Mentor and develop staff to deepen their knowledge of reimbursement regulations, reporting, and methodologies.
• Support talent development and succession planning by identifying growth opportunities and preparing high-potential staff for future leadership roles.
• Work cross-functionally with leaders and staff from various departments and backgrounds to address complex reimbursement and compliance matters.
• Communicate complex, variable reimbursement and regulatory issues in clear, concise narratives to support strategic decision-making.
• Provide analytical and subject matter support to broader strategic and financial initiatives as needed.

Requirements:

• Bachelor’s Degree in business, finance, health or public administration or a related field
• Master’s Degree in business, health or public administration, management, or related field strongly preferred
• Minimum ten (10) years of progressively responsible and directly related work experience required
• Preferred experience as an auditor working with CMS or a CMS Medicare Auditor Contractor and strong familiarity with Medicare and Medicaid regulations.
• Advanced knowledge of CMS and state Medicaid reimbursement principles and practices.
• Multi-year skill and experience managing business processes for organizations using a major ERP system.
• Ability to communicate complex concepts in simple form to non-finance users to understand the appropriate use and limits of the information provided.
• Ability to communicate and present complex issue with government agencies to resolve audit issues.
• Ability to manage, organize, prioritize, multi-task and adapt to changing priorities.
• Ability to foster effective working relationships and build consensus.
• Ability to partner in the development and achievement of goals, vision, and overall direction of the Controller’s Office at Stanford Health Care.
• Ability to provide clear and concise information/presentations to Senior Executive Team.
• Ability to develop strong team culture and working relationship with colleagues across the health system.
• Ability to drive a culture of proactive, integrated, responsive, high quality financial analysis.
• Ability to effectively manage deliverables and timelines.

Benefits:

• Health insurance
• 401(k) matching
• Flexible work hours
• Paid time off
• Professional development opportunities

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