AVP, Reimbursement - Jefferson Health

Jefferson Health Plans•Philadelphia, PA

20d•Onsite

About The Position

The Associate Vice President of Reimbursement leads Jefferson Health’s enterprise government reimbursement strategy, regulatory reporting, and payment optimization initiatives. The role oversees the preparation, review, certification, and filing of Medicare and Medicaid cost reports; directs audits, reopenings, appeals, and settlements; advises senior leadership on reimbursement risks and opportunities; and develops approaches to strengthen financial performance, regulatory compliance, and consistency across hospitals, regions, and affiliated entities. The position works across reimbursement methodologies and state supplemental payment programs, develops reimbursement assumptions for budgets and forecasts, and partners with finance, accounting, revenue cycle, legal, compliance, operations, clinical leadership, and external advisors. It also represents the organization with governmental agencies and other external stakeholders and leads the reimbursement team, including performance management and staff development.

Requirements

Bachelor’s degree in accounting, finance, health administration, or a related field.
10 years of progressively responsible hospital reimbursement experience, including complex Medicare and Medicaid cost reporting, audits, settlements, and payment analysis.
Prior experience leading professional reimbursement or finance staff, including goal setting, delegation, staff development, succession planning, and performance management.
Experience directing complex financial close, audit, budgeting, forecasting, regulatory reporting, and cross-functional decision-support processes.
Comprehensive knowledge of Medicare and Medicaid regulations, cost-reporting requirements, and hospital payment methodologies.
Ability to establish and maintain reimbursement policies, procedures, governance standards, internal controls, and supporting documentation.
Ability to interpret complex regulations, assess financial and operational effects, formulate defensible positions, and translate findings into actionable recommendations.
Strong executive communication and presentation skills, including explaining complex financial matters to senior leaders, auditors, operational partners, and other stakeholders.
Strong project-management and change-leadership skills, including guiding cross-functional initiatives, organizational integrations, and process standardization.
Ability to manage multiple priorities, exercise sound judgment, and deliver accurate, timely results in a complex and changing regulatory environment.
Advanced proficiency in spreadsheet modeling, reimbursement systems, financial reporting platforms, and data-analysis tools.
Ability to build effective relationships, influence decisions, and collaborate across finance, operations, clinical, legal, compliance, and executive leadership functions.

Responsibilities

Lead enterprise government reimbursement strategy and identify, evaluate, and realize Medicare and Medicaid payment opportunities.
Oversee preparation, review, certification, and filing of Medicare and Medicaid cost reports and other required government submissions.
Direct cost-report audits, reopenings, appeals, and settlement activities, ensuring positions are timely, supported, defensible, and compliant.
Establish reimbursement policies, procedures, governance standards, and internal controls across assigned entities.
Monitor and interpret Medicare and Medicaid regulations, assess their financial and operational impacts, and advise senior leadership on risks, opportunities, and actions.
Provide subject-matter leadership for disproportionate share hospital payments, graduate medical education, wage index, geographic reclassification, value-based purchasing, and other government payment methodologies.
Direct participation in state supplemental payment programs, including strategy, data validation, submissions, reconciliation, and compliance monitoring.
Develop reimbursement assumptions for the annual operating budget, long-range plan, financial forecasts, and period-end close; evaluate variances and recommend adjustments or reserves.
Partner with internal functions and external advisors to resolve complex reimbursement matters and support enterprise initiatives, integrations, and transactions.
Represent the organization with governmental agencies, auditors, contractors, consultants, and other external stakeholders, as appropriate.
Build and lead a high-performing reimbursement team, setting expectations, delegating, managing performance, providing feedback, and creating development and succession opportunities.

Benefits

Medical insurance, including prescription coverage
Supplemental insurance
Dental insurance
Vision insurance
Life and AD&D insurance
Short- and long-term disability insurance
Flexible spending accounts
Retirement plans
Tuition assistance
Voluntary benefits, including access to group insurance rates and discounts
Tuition discounts at Thomas Jefferson University after one year of full-time service or two years of part-time service
Medical insurance access for all colleagues, including those working less than part-time