Director Medicaid Reimbursement

Skills

• Strong background in accounting and financial analysis
• Leadership skills in management role
• Knowledge of current laws and regulations of the federal and state Medicaid programs
• Strategic thinking and ability to identify new reimbursement mechanisms
• Ability to communicate effectively with stakeholders
• Experience in healthcare finance, preferably in reimbursement including medicare, medicaid reimbursement and regulatory cost reporting

Qualifications

• Bachelor's degree in Accounting, Finance, or related field
• Master's degree in Accounting, Finance, or related field (preferred)
• 10+ years of relevant experience in healthcare finance, preferably in reimbursement including medicare, medicaid reimbursement and regulatory cost reporting
• 5+ years of proven leadership skills in management role

Responsibilities

• Leads a team of reimbursement professionals, providing guidance, training, and development opportunities
• Maintain a strong working knowledge of current laws and regulations of the federal and state Medicaid programs
• Ensures data, payments, settlements, audits, and financial entries are completed
• Communicate technical positions/arguments effectively to Medicaid auditors to support positions
• Leverage reimbursement expertise to identify strategic opportunities supporting long-term reimbursement optimization and sustainability
• Propose year-end estimated Medicaid third-party financial settlement to be audited by AdventHealth’s external auditor for inclusion in the audited financial statements
• Proactively seeks to improve strategy and reduce risks
• Creates solutions in compliance with regulations
• Collaborates with key stakeholders to support the reimbursement initiative and to identify, plan and execute reimbursement strategy
• Collaborates with other large system reimbursement leadership to identify best practices and incorporate learnings within the organization
• Engages in continuous knowledge development regarding healthcare industry developments, best practices, tools and techniques
• Responsible for ensuring that the potential of future take backs, is understood, communicated, and managed appropriately
• Educates Finance, Revenue, Cycle & Operational Leaders on regulations & impacts
• Communicate with key stakeholders on opportunities and impact, both regarding current issues as well as fundamentals of reimbursement for those in new roles
• Provides mentoring and coaching to staff, develops future financial leaders, recruits top-tier talent
• Utilizes excellent communication skills, including adjusting or adapting messaging for different stakeholders
• Participates in and/or lead special projects as assigned

About the role

This role serves as AdventHealth subject matter resource for Medicaid reimbursement matters. The role is focused on Medicaid payment areas and involves leading a team of reimbursement professionals, maintaining a strong working knowledge of current laws and regulations, ensuring data and financial entries are completed, communicating effectively with Medicaid auditors, leveraging reimbursement expertise to identify strategic opportunities, proposing year-end estimated Medicaid financial settlements, proactively seeking to improve strategy and reduce risks, collaborating with key stakeholders, engaging in continuous knowledge development, and educating Finance, Revenue, Cycle & Operational Leaders on regulations and impacts.