AVP, Reimbursement - Jefferson Health

Health Partners Plans; Philadelphia (Philadelphia County); On-site; USD 180,000 - 280,000; Full time

Job summary

Health Partners Plans seeks an Associate Vice President of Reimbursement to lead government reimbursement strategy, regulatory reporting, and payment optimization enterprise-wide. This role oversees Medicare/Medicaid cost reports, audits, and regulatory inquiries, guiding leadership on risks and opportunities with strong controls and documentation.

You will advise executive leadership, collaborate across finance, legal, operations, and clinical teams, and direct a team focused on achieving

Qualifications

• Bachelor's degree in accounting, finance, health administration, or a related field.
• 10 years of progressively responsible hospital reimbursement experience, including Medicare/Medicaid cost reporting, audits, settlements, and payment analysis.
• Experience leading professional reimbursement or finance staff, including goal setting, delegation, staff development, succession planning, and performance management.
• Experience directing complex financial close, audit, budgeting, forecasting, regulatory reporting, and cross-functional decision-support processes.
• Comprehensive knowledge of Medicare/Medicaid regulations, cost-reporting requirements, and hospital payment methodologies.
• Ability to interpret complex regulations, assess financial and operational effects, formulate defensible positions, and translate findings into actionable recommendations.
• Strong executive communication and presentation skills for senior leaders, auditors, and partners.
• Strong project-management and change-leadership skills for cross-functional initiatives.

Responsibilities

• Lead enterprise government reimbursement strategy, including Medicare/Medicaid opportunities across hospitals and regions.
• Oversee preparation, review, certification, and filing of Medicare/Medicaid cost reports and other government submissions.
• Direct cost-report audits, reopenings, appeals, and settlement activities with compliant documentation.
• Establish reimbursement policies, governance standards, and internal controls for reliable reporting.
• Monitor proposed/regulatory changes; advise leadership on risks, opportunities and actions.
• Provide leadership for DSH payments, GME, wage index, and other government payment methodologies.
• Coordinate with finance, accounting, revenue cycle, legal, compliance, and clinical leadership on reimbursement matters.
• Develop budgeting assumptions, long-range plans, forecasts, and period-end close analyses.
• Represent the organization with governmental agencies, auditors, contractors, and external stakeholders.
• Build and lead a high-performing reimbursement team with clear expectations and development opportunities.

Skills

Executive leadership

Medicare/Medicaid reimbursement

Regulatory compliance

Audits & cost reports

Cross-functional collaboration

Education

Bachelor's degree in accounting/finance/health administration

Job description

Number of Positions In Requisition

1

Job Details

The Associate Vice President of Reimbursement leads the organization's government reimbursement strategy, regulatory reporting, and payment optimization initiatives across the enterprise. The position oversees the accurate and timely preparation, review, certification, and filing of Medicare and Medicaid cost reports; directs responses to audits, reopenings, appeals, and regulatory inquiries; advises senior leadership on reimbursement risks and opportunities; and develops strategies that strengthen financial performance, regulatory compliance, and consistency across hospitals, regions, and affiliated entities.

Job Description

Summary

The Associate Vice President of Reimbursement leads the organization's government reimbursement strategy, regulatory reporting, and payment optimization initiatives across the enterprise. The position oversees the accurate and timely preparation, review, certification, and filing of Medicare and Medicaid cost reports and other required government submissions, supported by effective controls and documentation.

Job Duties

• Lead enterprise government reimbursement strategy, including the identification, evaluation, and realization of Medicare and Medicaid payment opportunities across hospitals, regions, and affiliated entities.
• Oversee the accurate and timely preparation, review, certification, and filing of Medicare and Medicaid cost reports and other required government submissions, supported by effective controls and documentation.
• Direct cost-report audits, reopenings, appeals, and settlement activities, ensuring that organizational positions are timely, well supported, defensible, and compliant with applicable regulations.
• Establish reimbursement policies, procedures, governance standards, and internal controls that promote consistent, reliable reporting across assigned entities.
• Monitor and interpret proposed and final Medicare and Medicaid regulations, quantify financial and operational impacts, and advise senior leadership on risks, opportunities, and recommended actions.
• Provide subject-matter leadership for disproportionate share hospital payments, indirect and direct graduate medical education, wage index, geographic reclassification, value-based purchasing, and other government payment methodologies.
• Direct organizational participation in state supplemental payment programs, including strategy development, data validation, submission oversight, reconciliation, and compliance monitoring.
• Develop reimbursement assumptions for the annual operating budget, long-range plan, financial forecasts, and period-end close; evaluate variances and recommend appropriate financial adjustments or reserves.
• Partner with finance, accounting, revenue cycle, legal, compliance, operations, clinical leadership, and external advisors to resolve complex reimbursement matters and support enterprise initiatives, integrations, and transactions.
• Represent the organization in interactions with governmental agencies, auditors, contractors, consultants, and other external stakeholders, as appropriate.
• Build and lead a high-performing reimbursement team by setting clear expectations, delegating effectively, managing performance, providing constructive feedback, and creating development and succession opportunities.

Minimum Qualifications

• Bachelor's Degree in accounting, finance, health administration, or a related field.
• 10 years of progressively responsible hospital reimbursement experience, including responsibility for complex Medicare and Medicaid cost reporting, audits, settlements, and payment analysis.
• Prior experience leading professional reimbursement or finance staff, including responsibility for goal setting, delegation, staff development, succession planning, and performance management.
• Experience directing complex financial close, audit, budgeting, forecasting, regulatory reporting, and cross-functional decision-support processes.
• Comprehensive knowledge of Medicare and Medicaid regulations, cost-reporting requirements, and hospital payment methodologies.
• Demonstrated ability to establish and maintain effective reimbursement policies, procedures, governance standards, internal controls, and supporting documentation.
• Ability to interpret complex regulations, assess financial and operational effects, formulate defensible positions, and translate findings into actionable recommendations.
• Strong executive communication and presentation skills, including the ability to explain complex financial matters clearly to senior leaders, auditors, operational partners, and other stakeholders.
• Strong project-management and change-leadership skills, with the ability to guide cross-functional initiatives, organizational integrations, and