Senior Director System Reimbursement

Geisinger•Work from home (Pennsylvania), PA

4d•Remote

About The Position

Provides enterprise-wide strategic and operational leadership for reimbursement and patient service revenue recognition ensuring alignment with regulatory requirements. The role is responsible for ensuring the integrity, completeness, and accuracy of net patient service revenue and third-party settlement estimates in accordance with GAAP. It involves overseeing methodologies for financial estimates, monitoring variances, and conducting hindsight analysis. The position also leads the development of advanced analytics and tools to provide insights into reimbursement trends, denial drivers, and the financial impact of value-based care. A key aspect is proactively monitoring and interpreting evolving federal and state reimbursement regulations and payer methodologies, translating these into actionable strategies for compliance. The role requires synthesizing complex regulatory changes into clear, executive-level insights, including financial impacts, risks, and recommended strategic responses. It oversees the timely and accurate completion and submission of all third-party cost reports and other reimbursement reports. The position manages all interactions with Medicare Administrative Contractors and other payors, including audit management, settlement reviews, and appeal strategies. It directs research and data accumulation for formal appeals and exception requests. The role ensures compliance with all applicable federal and state reimbursement regulations, including CMS rules and Medicare/Medicaid payment methodologies across various entities. Strategic and technical guidance is provided on graduate medical education reimbursement. The Senior Director serves as a strategic advisor in evaluating regulatory and legislative changes, partnering with Government Relations to influence policy. Building and developing a high-performing team through talent management and succession planning is crucial. The role champions the adoption of reimbursement and revenue analytics technologies and provides subject matter expertise for mergers, acquisitions, and new business models.

Requirements

Bachelor's Degree- (Required)
Minimum of 8 years-Finance (Required)
Minimum of 5 years-Managerial/Supervisory (Required)
Analytical Thinking
Communication
Computer Literacy
Healthcare Industry
Organizing
Teamwork

Nice To Haves

Master's Degree- (Preferred)

Responsibilities

Ensures the integrity, completeness, and accuracy of net patient service revenue, and third-party settlement estimates, in accordance with GAAP.
Oversees methodologies supporting financial estimates and continuously monitors variance, hindsight analysis, and emerging trends.
Leads the development of advanced analytics and tools (e.g., dashboards, predictive models) that provide actionable insights into reimbursement trends, denial drivers, and the financial impact of value-based and quality reimbursement programs.
Proactively monitors and interprets evolving federal and state reimbursement regulations and payer methodologies, translating changes into actionable strategies that maintain full regulatory compliance.
Synthesizes complex regulatory changes and reimbursement dynamics into clear, executive-level insights, including quantified financial impacts, risks, and recommended strategic responses for senior leadership and governance committees.
Oversees the timely and accurate completion and submission of all third-party cost reports and other reimbursement reports or correspondence which may be required by third-party payors and/or government agencies.
Oversees all interactions with Medicare Administrative Contractors and other payors, including audit management, settlement reviews, and appeal strategies, ensuring optimal financial outcomes and defensible positions.
Directs the research and accumulation of data for filing of formal appeals, re-opening requests, exception requests to rates or payment methodologies to support the Geisinger's position on governmental and third-party regulations.
Ensures compliance with all applicable federal and state reimbursement regulations, including CMS rules, Medicare/Medicaid payment methodologies, and related billing and documentation requirements across hospital, professional, and academic entities.
Provides strategic and technical guidance on graduate medical education reimbursement, including modeling, affiliation agreements, and compliance with CMS resident cap regulations.
Serves as a strategic advisor in evaluating proposed regulatory and legislative changes, partnering with Government Relations to influence policy through data-driven analysis, formal comment letters, and industry engagement.
Builds and develops a high-performing team through strategic talent management, succession planning, and a culture of accountability, continuous improvement, and cross-functional collaboration.
Champions the adoption and optimization of reimbursement and revenue analytics technologies, including automation tools and advanced modeling platforms, to improve accuracy, efficiency, and scalability.
Provides subject matter expertise on reimbursement and revenue recognition implications for mergers, acquisitions, affiliations, and new business models, including due diligence, integration planning, and pro forma financial impact analysis.