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Scheduled Weekly Hours:
40
Work Shift:
Days (United States of America)
SYSTEM DIRECTOR REIMBURSEMENT : REMOTE
Leads an assigned state portfolio within the enterprise Reimbursement function, operating at the State/Market level of the BSMH Operating Model as the enterprise reimbursement point of contact for assigned state and market leadership. Directly accountable for assigned reimbursement workstreams across the full reimbursement value chain — including cost reporting, Medicare and Medicaid payment integrity, regulatory analysis, audit defense, settlement, and strategic advisory — and collaborates closely with Revenue Cycle, Finance, Legal, Compliance, and operational partners to protect reimbursement yield and ensure defensible reimbursement outcomes across the assigned state portfolio. Applies enterprise reimbursement standards as the default; identifies and coordinates state-specific adaptations within approved governance where the assigned state's regulatory environment, payer landscape, or operational requirements necessitate them. The System Director is accountable for assigned hospitals, markets, provider types, and reimbursement workstreams within the state portfolio — including related quality, deadline, control, and stakeholder outcomes — and serves as a subject matter expert for designated specialized reimbursement areas. The System Director provides leadership to Directors, Managers, and Senior Analysts, supports enterprise standards and controls, ensures executive and CFO-facing transparency for the assigned state portfolio, and escalates material risks across the broader reimbursement operating model.
Essential Functions:
Reimbursement Operating Model Leadership
Lead the reimbursement operating model for the assigned state portfolio and its markets — ensuring direct accountability for assigned cost reporting, Medicare and Medicaid payment integrity, regulatory analysis, audit, settlement, and strategic advisory activities, in collaboration with Revenue Cycle, Finance, Legal, Compliance, and assigned state and market operational partners. Apply enterprise reimbursement standards as the default across the assigned state portfolio; identify and coordinate state-specific adaptations within approved governance where regulatory, payer, or operational requirements of the assigned state market necessitate them, and escalate exception requests and novel positions to the VP, Reimbursement. Direct Directors, Managers, Senior Analysts, and technical leaders responsible for the assigned state portfolio and matrixed GBS support. Set priorities, allocate resources, manage spans of responsibility, and maintain succession and contingency plans.
Reimbursement Policy and Rate Intelligence
Monitor and model the impact of proposed and final CMS rules, state Medicaid rate changes, and legislative developments on the assigned state portfolio. Provide proactive financial impact analysis to the VP, Reimbursement and assigned market CFOs before rules are finalized, and ensure regulatory change is translated into reimbursement, cost report, and cross-functional action planning with appropriate lead time. Maintain a regulatory calendar covering applicable Medicare and Medicaid payment updates, state Medicaid program changes, and state-specific reporting deadlines. Monitor state hospital association communications and state-level legislative activity as it affects reimbursement for the assigned state portfolio.
Cost Report Monitoring and Reimbursement Positioning
Oversee routine monitoring of key reimbursement drivers for the assigned state portfolio, including cost report statistical basis, GL-to-cost-report mapping, DSH and GME positions, wage index data, and interim settlement projections. Maintain a defined monthly reconciliation cadence across core monitoring streams — statistical basis, cost center and GL, DSH/GME and special payment, and interim payment and settlement…