System Government Reimbursement Director

CAMC Health System•Charleston, WV

About The Position

The System Government Reimbursement Director oversees government reimbursement processes across the organization, ensuring regulatory and accounting compliance while optimizing reimbursement strategies to support revenue and the organization’s financial health and strategic goals. The role provides system-wide leadership for reimbursement across hospitals, physician practices, provider-based clinics, rural health clinics, critical access hospitals, and other provider entities. The Director leads government cost reporting, audits, desk reviews, appeals, reimbursement forecasting, and analytics. This includes oversight of Medicare and Medicaid revenue, supplemental payment programs, provider taxes, DSH, UPL, directed payments, GME/IME, and value-based reimbursement. The role evaluates reimbursement impacts from regulatory changes, payer initiatives, acquisitions, mergers, affiliations, hospital conversions, and new provider entities, and provides financial modeling and recommendations to executive leadership. The position works with finance, population health, care management, revenue integrity, coding, CDI, patient financial services, decision support, and managed care contracting teams. It also monitors federal and state reimbursement developments, supports industry advocacy, educates operational and financial leaders, and participates in reimbursement governance. The role is based in Charleston, West Virginia, and is listed as full-time regular, 1.0 FTE, with a day schedule.

Requirements

Bachelor’s degree in Accounting.
10 years of progressive healthcare experience with concentrated involvement in Medicare and Medicaid programs.
Demonstrate competency through initial orientation and ongoing competency validation to independently perform assigned tasks and duties.

Nice To Haves

Advanced education.
Certified licenses.

Responsibilities

Develop and execute the system-wide government reimbursement strategy across hospitals, physician practices, provider-based clinics, rural health clinics, critical access hospitals, and other provider entities.
Identify reimbursement optimization opportunities through regulatory analysis, program participation, service line expansion, and operational improvements.
Provide executive leadership with financial modeling and strategic recommendations related to reimbursement changes, regulatory proposals, and payer initiatives.
Lead government reimbursement cost report submissions, audits, desk reviews, and appeals.
Develop and maintain internal controls supporting reimbursement compliance and financial reporting, and ensure documentation supports reimbursement positions in cost reports and governmental filings.
Own system-level government reimbursement forecasts and long-range financial projections.
Develop reimbursement analytics and dashboards covering Medicare, Medicaid, supplemental payments, DSH, UPL, directed payments, provider taxes, GME/IME, and value-based reimbursement programs.
Assess the financial impact of MSSP ACO programs, bundled payments, episodes of care, Medicaid managed care initiatives, and other alternative payment methodologies.
Collaborate with Population Health, Care Management, and Finance leadership to maximize performance under value-based reimbursement programs.
Coordinate preparation and submission of reimbursement-related comments and advocacy materials through industry associations when appropriate.
Monitor federal and state legislation, CMS proposed and final rules, and reimbursement changes; communicate relevant developments to appropriate parties.
Lead organizational analysis of reimbursement implications associated with IPPS, OPPS, the Physician Fee Schedule, Medicaid methodologies, and supplemental payment programs.
Manage and oversee DSH, UPL, directed payment, provider assessment, and Graduate Medical Education reimbursement programs.
Identify opportunities to maximize supplemental reimbursement while maintaining regulatory compliance.
Conduct reimbursement due diligence for hospital, physician practice, and other healthcare acquisitions; assess related risks and opportunities.
Lead integration of reimbursement processes and cost-reporting structures for newly acquired entities.
Evaluate reimbursement impacts of acquisitions, mergers, hospital conversions, and new provider entities.
Partner with Revenue Integrity, Coding, CDI, Patient Financial Services, Decision Support, and Managed Care contracting teams to improve reimbursement accuracy.
Identify operational or charging issues that materially affect Medicare and Medicaid reimbursement and participate in system reimbursement optimization initiatives.
Chair or participate in a System Reimbursement Governance Committee.
Present reimbursement updates, financial impacts, and regulatory developments to executive leadership and finance committees.
Provide education to operational and financial leaders regarding reimbursement changes and emerging risks.
Maintain and document required education; demonstrate positive customer service and coworker relations; comply with attendance, departmental, and organizational policies; participate in quality improvement; perform work cost-effectively and in alignment with the organization’s mission and strategic plan; and perform related duties as assigned.