Director – Reimbursement

Job Description: • Ensure timely and accurate filing of annual government cost reports, including Medicare, Medi-Cal, and HCAI submissions. • Maintain comprehensive knowledge of federal and state reimbursement laws and regulations to maximize reimbursement. • Develop, implement, and maintain internal policies and procedures to ensure complete and accurate capture of all legitimate reimbursement opportunities. • Oversee Medicare and Medi-Cal audit processes, addressing inquiries and pursuing appeals or litigation when necessary (e.g., CMS disputes). • Review third-party contractual allowances, settlements, and variances (actual vs. budget) to support accurate financial reporting. • Participate in the annual budget development process by providing detailed analysis and projections related to government payor net income. • Prepare and respond to year-end financial audits, specifically related to third-party liabilities and balance sheet reserves. • Serve as the subject matter expert on regulatory compliance reporting, including Medicare and Medi-Cal cost reports • Lead alignment of compliance reporting processes across SHC-related entities and partner organizations. • Continuously assess and improve reimbursement and reporting processes to increase efficiency, accuracy, and scalability. • Oversee invoicing, contract compliance, and financial administration for non-patient care service agreements, such as Graduate Medical Education (GME) affiliation agreements and Physician outreach and other academic/clinical support contracts. • Coordinate with internal department, affiliated entities, and external partners to ensure contract terms are accurately maintained and executed. • Ensure obligations are properly managed and tracked within the Workday customer management model. • Serve as the subject matter expert for the Workday customer management model, assisting in the development and enhancement of business process workflows. • Participate in system testing and user acceptance activities related to workflow improvements and updates within Workday. • Promote a culture of learning, continuous improvement, and compliance across the reimbursement function. • Mentor and develop staff to deepen their knowledge of reimbursement regulations, reporting, and methodologies. • Support talent development and succession planning by identifying growth opportunities and preparing high-potential staff for future leadership roles. • Work cross-functionally with leaders and staff from various departments and backgrounds to address complex reimbursement and compliance matters. • Communicate complex, variable reimbursement and regulatory issues in clear, concise narratives to support strategic decision-making. • Provide analytical and subject matter support to broader strategic and financial initiatives as needed. Requirements: • Bachelor’s Degree in business, finance, health or public administration or a related field • Master’s Degree in business, health or public administration, management, or related field strongly preferred • Minimum ten (10) years of progressively responsible and directly related work experience required • Preferred experience as an auditor working with CMS or a CMS Medicare Auditor Contractor and strong familiarity with Medicare and Medicaid regulations. • Advanced knowledge of CMS and state Medicaid reimbursement principles and practices. • Multi-year skill and experience managing business processes for organizations using a major ERP system. • Ability to communicate complex concepts in simple form to non-finance users to understand the appropriate use and limits of the information provided. • Ability to communicate and present complex issue with government agencies to resolve audit issues. • Ability to manage, organize, prioritize, multi-task and adapt to changing priorities. • Ability to foster effective working relationships and build consensus. • Ability to partner in the development and achievement of goals, vision, and overall direction of the Controller’s Office at Stanford Health Care. • Ability to provide clear and concise information/presentations to Senior Executive Team. • Ability to develop strong team culture and working relationship with colleagues across the health system. • Ability to drive a culture of proactive, integrated, responsive, high quality financial analysis. • Ability to effectively manage deliverables and timelines. Benefits: • Health insurance • 401(k) matching • Flexible work hours • Paid time off • Professional development opportunities Apply tot his job Apply To this Job