Director of Medicare/Medicaid Reimbursement

Position Summary:

Our customer is looking for a Director of Medicare/Medicaid Reimbursement to provide executive-level oversight of financial analysis, processes, accounting, and reporting for reimbursement activities across system hospitals.

Responsibilities:

• Maintain knowledge of current Medicare/Medicaid regulations and ensure system-wide compliance; disseminate regulatory changes to appropriate management levels to foster informed decision-making.
• Provide executive education on IME, GME, Provider Based rules, rural status, and other reimbursement topics; deliver executive summaries of reimbursement impact to senior leaders.
• Review Medicare/Medicaid cost reports with emphasis on accurate reimbursement, including CHAMPUS Capital and GME cost reports for each hospital.
• Oversee staff completion of time studies, rotation schedules, statistics, and bad debt logs throughout the fiscal year needed to complete annual cost reports.
• Identify and implement opportunities to optimize reimbursement, including 340B discount capture, provider number consolidation/separation, IPPS/OPPS rule analysis, and geographical wage index reclassifications.
• Review monthly close for third-party settlement accounts; ensure each hospital is accurately reserved and review year-end Medicare settlement schedules to maintain proper third-party liability accounts.
• Oversee staff responses to Medicare/Medicaid Intermediary to settle cost report audits; review third-party reimbursement packages for external audit annually.
• Review LIP and DPP schedules prepared by staff to ensure accuracy and achieve maximum allowable reimbursement.
• Review provider-based attestations for outpatient centers created through system expansion; support 340B site enrollment and MGCRB reclassification requests where beneficial.
• Develop reimbursement skills across staff; provide reimbursement expertise on cross-functional project teams and strategic initiatives incorporating regulatory reimbursement concerns.
• Maintains compliance with all Orlando Health policies and procedures.

Other Related Functions:

• Effectively communicates complex financial models to a wide variety of audiences through verbal and written presentations.
• Manages large projects and oversees leadership of cross-functional teams.
• Participates in/attends meetings as required; may be asked to chair or lead.
• Completes all Orlando Health mandatory education.
• Assumes responsibility for professional development; maintains CPA license through ongoing CPE.

Education/Training:

Bachelor's degree in Accounting, Finance, or Business Administration required.

Licensure/Certification:

CPA preferred.

Experience:

10 years in a leadership role within a complex health system required. Background in preparing and reviewing Medicare cost reports, coordinating audits, and managing reimbursement functions at a system level. Proficiency with reimbursement software and Microsoft Office; experience with HFS, SQL, Absolute, Lawson, and Epic a plus.