Director Cost Reports DSH - Medicare Bad Debt - UCA

FinThrive

About The Position

The Director, Cost Reports serves as a senior, client‑facing leader and subject‑matter expert in Medicare cost reporting, with deep specialization in Disproportionate Share Hospital (DSH), Medicare Bad Debt, and Uncompensated Care (UCA). This role blends advanced technical expertise with consultative leadership, team development, and strategic influence across client engagements, internal operations, and product and sales partnerships. The Director is responsible for leading complex reimbursement engagements, guiding clients through regulatory and audit complexity, and developing the next generation of reimbursement experts through structured training, mentoring, and knowledge sharing. Impact you will make Act as a trusted advisor to hospital and health system clients, providing authoritative guidance on Medicare cost reporting and reimbursement optimization Drive consistent, compliant, and high‑quality delivery across DSH, Bad Debt, and UCA engagements Coordinate reimbursement knowledge and best practices across, operations, sales, product, and customer success teams Translate regulatory complexity into actionable strategies for clients and internal teams Build a high‑performing reimbursement team by investing in coaching, mentoring, and formalized training Influence organizational strategy through insights derived from regulatory research, client outcomes, and market trends

Requirements

15+ years of experience in Medicare reimbursement, cost reporting, or healthcare finance
Deep expertise in DSH, Medicare Bad Debt, UCA, and Medicare cost report preparation
Proven ability to interpret and apply CMS regulations in complex, real‑world scenarios
Strong analytical and problem‑solving skills with exceptional attention to detail
Demonstrated success in client‑facing advisory or consulting roles
Experience training, mentoring, and developing Cost Report
Ability to explain complex regulatory concepts clearly to both technical and non‑technical audiences
Executive‑level presentation and facilitation skills
Confidence operating as a subject‑matter authority and escalation point
Advanced proficiency in Microsoft Excel and reimbursement analysis tools
Ability to work independently while collaborating across functions in a fast‑paced consulting environment
Willingness to travel up to 50%, based on client and project needs

Nice To Haves

Bachelor’s degree in healthcare administration, Finance, Accounting, or a related field preferred.
Experience working within a hospital or health system environment
Exposure to EHR platforms such as Epic, Cerner, Meditech, or McKesson
Prior experience in consulting, MAC environments, or reimbursement outsourcing models

Responsibilities

Serve as a senior consulting leader for Medicare cost report, DSH, UCA, and Medicare Bad Debt engagements
Advise clients on regulatory compliance, audit risk, reopening opportunities, and reimbursement optimization strategies
Lead complex client discussions, including audit preparation, appeal strategy, and executive‑level presentations
Provide year‑over‑year analysis of client results to identify trends, risks, and revenue opportunities
Leverage industry credibility to deliver trusted, defensible guidance aligned with CMS rules and best practices
Monitor CMS and industry communications for changes impacting Medicare Bad Debt, DSH, UCA, and cost reporting
Research and interpret regulatory updates, auditor guidance, and policy changes
Translate regulatory changes into internal guidance, client advisories, and delivery standards
Partner with leadership to assess the strategic impact of regulatory changes on service offerings and company direction
Work closely with Finance to inform revenue forecasting and financial strategy, leveraging cost report results, audit insights, and regulatory changes to improve forecast accuracy and risk visibility.
Partner with Sales to support prospect education, opportunity identification, and solution positioning
Collaborate with Product and Technology teams to ensure reimbursement solutions align with regulatory requirements and market needs
Work with Customer Success to identify compliance gaps, develop remediation strategies, and improve client outcomes
Provide strategic insights to leadership to inform roadmap, pricing, and service development decisions
Direct and oversee cost report production and audit support teams across multiple concurrent engagements
Establish delivery standards, timelines, quality controls, and review protocols for Medicare cost reports
Manage and balance team workloads to ensure timely filings, audit readiness, and sustained performance
Review and approve complex cost reports, workpapers, and audit submissions prior to filing
Lead audit preparation, audit response activities, and coordination with CMS, MACs, and state agencies
Identify and implement process improvements that increase efficiency, accuracy, and scalability
Directly manage and coach managers, and senior reimbursement professionals
Establish performance expectations and conduct regular performance reviews and development planning
Identify staffing needs, participate in hiring and onboarding, and support succession planning
Design and deliver structured training programs related to DSH, Medicare Bad Debt, UCA, and cost reporting
Mentor team members to build both technical expertise and consultative leadership skills
Foster a culture of accountability, continuous improvement, and professional growth