AVP, Government Reimbursement

Ensemble Health Partners; Kentucky; Hybrid; USD 140,000 - 170,000; Full time

Benefits offered by this job

Healthcare benefits

Tuition reimbursement

Bonuses and incentive programs

Job summary

Ensemble Health Partners is seeking an Assistant Vice President of Government Reimbursement to advise large health systems on Medicare/Medicaid reimbursement, DSH, 340B, and related cost reporting. The role focuses on optimizing revenue while ensuring federal compliance and strong client partnerships.

The position emphasizes leadership, strategic advisory, and expertise in government reimbursement policies, with responsibilities spanning audits, appeals, and payer negotiations.

Qualifications

Responsibilities

• Assist in gathering and analyzing data for Medicare cost reports and reimbursement optimization.
• Provide expert advice on reimbursement strategies for governmental lines of business, including Medicaid and Tricare.
• Support 340B program compliance, eligibility, and ensure correct billing processes.
• Analyze hospital eligibility for DSH payments and Medicaid days to ensure accurate capture and revenue impact.
• Monitor Medicaid Directed Payment programs to maximize revenue opportunities for providers.
• Advise clients on reimbursement-related matters and maintain knowledge of CMS guidelines and HRSA 340B regulations.

Job description

Thank you for considering a career at Ensemble! Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference!

O.N.E Purpose:

• Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations.
• Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation.
• Striving for Excellence: Execute at a high level by demonstrating our “Best in KLAS” Ensemble Difference Principles and consistently delivering outstanding results.

The Opportunity: Assistant Vice President, Government Reimbursement By embodying our core purpose of customer obsession, new ideas, and driving innovation, and delivering excellence, you will help ensure that every touchpoint is meaningful and contributes to our mission of redefining the possible in healthcare. This role will serve in a consultancy capacity, advising our clients, large health systems, in managing and optimizing healthcare reimbursement processes, focusing on Medicare, Medicaid, Disproportionate Share Hospital (DSH) programs, Medicaid Directed Payment programs, and 340B drug pricing and reimbursement. Additionally, this position provides key support in the preparation and analysis of Medicare cost reports, ensuring compliance with federal regulations and maximizing financial performance for healthcare providers.

Essential Job Functions

Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations. Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation. Striving for Excellence: Execute at a high level by demonstrating our “Best in KLAS” Ensemble Difference Principles and consistently delivering outstanding results.

• Assist in gathering and analyzing data for the preparation of Medicare cost reports, ensuring accurate reflection of hospital costs for reimbursement optimization.
• Provide expert advice on reimbursement strategies for governmental lines of business, including Medicaid and Tricare.
• Support 340B program compliance, eligibility, and ensure correct billing processes.
• Analyze hospital eligibility for DSH payments, assess financial impact, and ensure complete and accurate capture of Medicaid days and other considerations.
• Monitor Medicaid Directed Payment programs, optimizing revenue opportunities for participating providers.
• Serve as a trusted advisor to clients, offering strategic insights and recommendations on reimbursement-related matters.
• Maintain expert-level knowledge of state and federal healthcare reimbursement policies, ensuring strict compliance with CMS guidelines, Medicaid Managed Care rules, and HRSA 340B program regulations.
• Assist healthcare providers in navigating reimbursement complexities, including audits, appeals, and compliance inquiries.
• Analyze financial data to identify trends and areas for improvement in the reimbursement process.
• Build and maintain strong relationships with payers, government agencies, and other stakeholders.
• Provide guidance and training to client staff on reimbursement regulations and best practices.

Job Competencies

• Leadership Decision Making Makes day-to-day leadership decisions by securing and comparing information from multiple sources to identify issues; commits to an action after weighing alternative solutions against important criteria; effectively communicates decisions to the appropriate people and teams and holds them accountable. Drives results.
• Coaching & Building Talent Achieves results through other leaders by empowering them and providing feedback, instruction and development (coaching the coach) to develop their own associates; plans and supports the growth of individual skills and abilities in preparation for their next role (building bench); focuses on retention of high performers.
• Delegation Successfully shares authority and responsibilities with others to move decision making and accountability downward through the organization while accomplishing strategic priorities; maintains personal ownership of outcomes without excessive involvement.
• Executive Communication Clearly and succinctly conveys information and ideas; communicates in a focused and compelling way that captures and holds others' attention (appropriate, impactful, and clear).
• Program/Project Management Demonstrates high accountability and responsibility for projects and programs from inception through completion/implementation; manages budget and resource planning and awareness to ensure maximized output, reduced waste and exceptional results.

Join an award-winning company

• Five-time winner of “Best in KLAS” 2020-2022, 2024-2025
• Black Book Research's Top Revenue Cycle Management Outsourcing Solution 2021-2024
• 22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle 2019-2024
• Leader in Everest Group's RCM Operations PEAK Matrix Assessment 2024
• Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance 2020, 2022-2023
• Energage Top Workplaces USA 2022-2024
• Fortune Media Best Workplaces in Healthcare 2024
• Monster Top Workplace for Remote Work 2024
• Great Place to Work certified 2023-2024
• Innovation Work-Life Flexibility Leadership Purpose + Values

Culture & Benefits

Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive.

• Associate Benefits – We offer a comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs.
• Growth – We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement.
• Recognition – We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.

Ensemble is an equal employment opportunity employer.

It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws. Ensemble also prohibits harassment of applicants or employees based on any of these protected categories.

Due to business, operational, payroll, and regulatory requirements, this position is limited to individuals who reside and are authorized to work within the United States. Applications generated from outside the United States will not be considered. Individuals may reapply when located within the United States. Ensemble provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require accommodation in the application process, please contact [e-mail].

This posting addresses state specific requirements to provide pay transparency. Compensation decisions consider many job-related factors, including but not limited to geographic location; knowledge; skills; relevant experience; education; licensure; internal equity; time in position. A candidate entry rate of pay does not typically fall at the minimum or maximum of the role’s range.

Ensemble is dedicated to providing our clients with experienced healthcare finance and revenue cycle professionals. We believe that our core values of trust, integrity, loyalty and service married with the belief that our work is worthwhile helps us build and sustain sincere relationships with our associates and clients. If you are a passionate, dedicated and experienced revenue cycle, consulting or finance professional and seek career and personal growth, we would love to hear from you. We believe we foster an environment where talented individuals can excel and shine. Our team believes that people are the most important part of our success and that when we take care of our people, they pay it forward by providing our clients with excellent results and world-class service.