Director System Reimbursement & Finance

LCMC Health•Irvine, CA

About The Position

The Director of Reimbursement & Finance is responsible for overseeing the government revenue reporting and reimbursement processes within the organization. This role involves ensuring compliance with regulatory and accounting requirements and optimizing reimbursement strategies to maximize revenue. The Director will collaborate with a team of finance professionals and collaborate with various departments to support the organization's financial health and strategic goals. The Director may be involved in the following: government net patient revenue modeling, evaluating coordinating preparation of cost reports, audits, appeals, establishing best practices for government revenue realization from third party payers, evaluating adequacy of third-party contractual allowances while being compliant with program rules and regulations in both the public and private sectors. General Duties Financial Reporting: Oversee, prepare, and present accurate and timely financial reports to senior management and stakeholders; Ensure adherence to accounting principles and regulatory requirements. Reimbursement Management: Oversee the reimbursement processes for government programs (e.g., Medicare, Medicaid); Coordinate the preparation, including as a preparer, cost reports for assigned facilities; facilitate the development of a standardized system reporting and analytical models, Monitor regulatory changes and ensure compliance with government payer policies and reimbursement rules considering wage index, geographic classification, GME/IME, etc. Licensure and 340B Liaison: Remain current on CMS and LDH licensure requirements as they relate to reimbursable vs non-reimbursable operations; Participate in hospital specific licensure meetings to understand operational strategies, evaluate the impact to the hospital cost report and coordinate operational updates to the appropriate cost report team; Serve as 340B Liaison for the LCMC Corporate 340B Team regarding new site licensure. site re-licensure and HRSA audit activities. Regulatory Monitoring: Serve as a key leader to monitor government updates (including both the Federal Register and Louisiana Register) for pending and/or final regulations that impact the LCMC System either operationally or financially, including but not limited to pharmacy/340B, licensure requirements, new government surveys, major changes in reimbursement methodologies that impact monthly accounting/annual cost reports/patient, etc. accounting systems. Strategic Initiatives: Partner with senior management to identify and pursue opportunities for financial growth and efficiency; Lead special projects and initiatives related to financial improvement and reimbursement optimization; Represent the finance function in cross-departmental projects and initiatives. Team Leadership and Development: Lead, mentor, and develop members of the reimbursement & finance team, fostering a culture of high performance and continuous improvement; Set performance goals and conduct regular performance evaluations; Provide training and development opportunities to enhance the skills and capabilities of the team.

Requirements

6 (Six) plus years of increasingly responsible positions in Third Party Reimbursement, GAAP, Governmental and Not-for profit accounting and financial reporting
Minimum: Bachelor’s degree in finance, Accounting, or a related field

Nice To Haves

MBA or CPA
CPA preferred

Responsibilities

Overseeing government revenue reporting and reimbursement processes
Ensuring compliance with regulatory and accounting requirements
Optimizing reimbursement strategies to maximize revenue
Collaborating with finance professionals and various departments
Government net patient revenue modeling
Evaluating coordinating preparation of cost reports, audits, appeals
Establishing best practices for government revenue realization from third party payers
Evaluating adequacy of third-party contractual allowances while being compliant with program rules and regulations in both the public and private sectors
Oversee, prepare, and present accurate and timely financial reports to senior management and stakeholders
Ensure adherence to accounting principles and regulatory requirements
Oversee the reimbursement processes for government programs (e.g., Medicare, Medicaid)
Coordinate the preparation, including as a preparer, cost reports for assigned facilities
Facilitate the development of a standardized system reporting and analytical models
Monitor regulatory changes and ensure compliance with government payer policies and reimbursement rules considering wage index, geographic classification, GME/IME, etc
Remain current on CMS and LDH licensure requirements as they relate to reimbursable vs non-reimbursable operations
Participate in hospital specific licensure meetings to understand operational strategies, evaluate the impact to the hospital cost report and coordinate operational updates to the appropriate cost report team
Serve as 340B Liaison for the LCMC Corporate 340B Team regarding new site licensure. site re-licensure and HRSA audit activities
Serve as a key leader to monitor government updates (including both the Federal Register and Louisiana Register) for pending and/or final regulations that impact the LCMC System either operationally or financially, including but not limited to pharmacy/340B, licensure requirements, new government surveys, major changes in reimbursement methodologies that impact monthly accounting/annual cost reports/patient, etc. accounting systems
Partner with senior management to identify and pursue opportunities for financial growth and efficiency
Lead special projects and initiatives related to financial improvement and reimbursement optimization
Represent the finance function in cross-departmental projects and initiatives
Lead, mentor, and develop members of the reimbursement & finance team, fostering a culture of high performance and continuous improvement
Set performance goals and conduct regular performance evaluations
Provide training and development opportunities to enhance the skills and capabilities of the team