Director of Reimbusement

Adventist HealthCare • Gaithersburg, MD

22d

About The Position

Adventist HealthCare seeks to hire an experienced Director of Reimbursement who will embrace our mission to extend God’s care through the ministry of physical, mental, and spiritual healing. The Director of Reimbursement is responsible for enterprise oversight of acute care reimbursement compliance, regulatory reporting, and payment policy execution for a $1B+ acute-care health system. This role leads financial reimbursement activities regulated by the Maryland Health Services Cost Review Commission (HSCRC) and supports acute care reimbursement and regulatory compliance across governmental and commercial payers. The Director implements established reimbursement strategies and manages reimbursement services through accurate financial reporting, analytics, and audit readiness to demonstrate compliance and identify opportunities for revenue optimization within Maryland’s all-payer model. In Maryland’s unique rate-setting environment, the Director serves as one of the health system’s subject matter experts for HSCRC & AHEAD compliance, financial filings, and related regulatory requirements, including global budget methodologies and price transparency standards. The Director partners closely with Finance, Strategic Analytics, Revenue Cycle, Case Management, and external auditors to optimize reimbursement, minimize regulatory risk, and ensure timely and accurate reporting across federal and state payment programs.

Requirements

• Bachelor’s degree in Finance, Accounting, Health Administration, or related field (Master’s preferred).
• 7–10 years of progressive reimbursement experience in an acute-care hospital or health system environment.
• Demonstrated expertise in Medicare cost reporting, wage index, charge master oversight, and reimbursement compliance.
• Strong understanding of governmental hospital rate regulation; Maryland HSCRC methodology experience preferred.
• Deep technical reimbursement and regulatory expertise
• Strong analytical and modeling skills (advanced Excel)
• Proven audit defense and compliance leadership
• Effective communicator with executive presence
• Ability to operate strategically in a complex regulated environment

Responsibilities

• Medicare Cost Reporting & Federal Reimbursement Oversight
• Direct the preparation, completion, and filing of the annual Medicare cost report for all acute-care hospitals within the system.
• Ensure compliance with CMS reimbursement rules, including cost allocation methodologies, provider-based regulations, and payment adjustments.
• Manage Medicare reimbursement audits, desk reviews, appeals, and related settlement activity.
• Oversee completion of the annual Medicare Wage Index and Occupational Mix Surveys, ensuring accuracy and optimizing reimbursement positioning.
• Lead enterprise Medicare & Medicaid reimbursement strategy.
• AHEAD and HSCRC Rate Compliance & Maryland Regulatory Reporting
• Provide leadership and oversight for HSCRC reimbursement policy execution, including compliance with Maryland all-payer rate-setting requirements and new AHEAD requirements.
• Ensure accurate preparation and submission of required HSCRC filings, including:
• Annual Hospital Filing
• Monthly financial reporting and volume monitoring
• Uncompensated Care (UCC) / charity care reporting
• Global Budget Revenue (GBR) compliance schedules
• Price variance and revenue integrity reconciliations
• Lead monthly earned revenue computation for financial reporting and operational implications, including charge master rate adjustments as needed to maintain compliance.
• Monitor HSCRC and AHEAD policy updates and translate methodology changes into financial action plans.
• Coordinate with Revenue Cycle and patient revenue management teams to support cash collection, revenue optimization, and compliant growth.
• Serve as a primary liaison with HSCRC staff on reimbursement compliance, reviews, and regulatory inquiries.
• Identify reimbursement opportunities and implement strategies aligned with system finance and strategic leadership. Collaborate with Strategic Analytics on reimbursement strategy and reimbursement policy performance
• Supervise preparation and support of reimbursement-related audits and statistical reports for HSCRC, Medicare, Medicaid, and other third-party payers, minimizing reliance on external consultants.
• Charge Master Integrity & Revenue Compliance
• Oversee the integrity of the hospital charge master, ensuring alignment with CPT/HCPCS requirements, CMS billing regulations, and HSCRC pricing compliance.
• Lead routine charge master audits, governance processes, and pricing review structures.
• Partner with coding, compliance, and revenue integrity teams to reduce billing risk and support accurate reimbursement.
• Collaborate with Finance and Revenue Cycle on optimization of charge capture, documentation, CMI and related policies.
• Reimbursement Analytics & Strategic Financial Support
• Analyze reimbursement trends across Medicare, Medicaid, commercial payers, and Maryland all-payer structures.
• Support financial modeling for reimbursement impacts related to volume shifts, service line growth, and regulatory policy updates.
• Prepare accounts receivable reserve and reimbursement analytics to support financial statement close.
• Provide reimbursement forecasting support in collaboration with Budgeting and Strategic Analytics.
• Support revenue budget development, including NPSR projections and patient service volume forecasting.
• Audit Management & External Relationship Oversight
• Manage reimbursement-related interactions with external auditors, consultants, CMS contractors, and HSCRC reviewers.
• Coordinate responses to audit activity and ensure documentation, controls, and defensibility are maintained.
• Leadership & Enterprise Collaboration
• Lead, mentor, and develop a high-performing reimbursement team.
• Partner with stakeholders across Finance, Revenue Cycle, Compliance, Case Management, Strategic Analytics, and operational leadership.
• Provide executive-level reporting on reimbursement performance, risks, and opportunities, translating complex reimbursement issues for senior leaders.
• Build strong internal and external relationships with regulatory peers and statewide partners.

Benefits

• Work life balance through nonrotating shifts
• Recognition and rewards for professional expertise
• Free Employee parking
• Medical, Prescription, Dental, and Vision coverage for employees and their eligible dependents effective on your date of hire
• Employer-paid Short & Long-Term Disability, Basic Life Insurance and AD&D, (short-term disability buy-up available)
• Paid Time Off
• Employer retirement contribution and match after 1-year of eligible employment with a 3-year vesting period
• Voluntary benefits include flexible spending accounts, legal plans, and life, pet, auto, home, long term care, and critical illness & accident insurance
• Subsidized childcare at participating childcare centers
• Tuition Reimbursement
• Employee Assistance Program (EAP) support

What This Job Offers

• Job Type: Full-time
• Career Level: Director