Director - Reimbursement & Managed Care (Remote)

MaineGeneral Health; Waterville (ME); Remote; USD 100,000 - 130,000; Full time

Job summary

A leading healthcare organization in Waterville is seeking a Director of Reimbursement and Managed Care to oversee reimbursement processes and payer relationships. The ideal candidate will have a strong background in healthcare finance and leadership experience, with a passion for providing exceptional healthcare services. This role offers a comprehensive benefits package and competitive salary.

Benefits

Health, dental, and vision benefits

Generous leave for new parents

Tuition Reimbursement

403(b) company-matching contributions

Short-term and long-term disability insurance

Qualifications

• Minimum of 7 years of experience in healthcare reimbursement and managed care.
• Proven track record in similar roles.
• Experience with leading teams.

Responsibilities

• Manage Charge Description Master (CDM) rate setting.
• Lead contract negotiations and manage payer relationships.
• Ensure compliance with price transparency regulations.
• Support the revenue budget process.

Skills

Healthcare finance understanding

Regulatory requirements knowledge

Problem-solving skills

Analytical skills

Communication skills

Negotiation abilities

Leadership skills

Education

Bachelor’s degree in Finance, Accounting, Business Administration or related field

Master’s degree in related field

Tools

Soarian

StrataJazz

Job description

Job Summary

MaineGeneral Health is a leading health care system proud of the culture of excellence, compassion, and collaboration that extends to our patients and their families. We are committed to attracting talented, ambitious people who share our values and strive to provide excellent customer service. We are actively seeking a finance professional to join our experienced team as the Director of Reimbursement and Managed Care who will oversee all aspects of reimbursement, managed care contracts, and payer enrollment.

The successful candidate will have a deep understanding of healthcare finance, regulatory requirements, and a proven track record in a similar role. Additionally, they will have a strong work ethic, intuitive problem-solving skills, and the drive to meet evolving organizational needs.

The Work

• Manage and oversee the Charge Description Master (CDM) rate setting
• Lead contract negotiations and manage payer relationships
• Utilize Soarian and StrataJazz contracting modules
• Perform contract modeling and troubleshoot payer issues
• Oversee contract management and reporting
• Ensure compliance with price transparency regulations
• Support the revenue budget process, including revenue/statistical variance analysis
• Prepare monthly and ad-hoc net revenue reporting
• Assist in service line analysis with FP&A
• Oversee cost reporting for most companies and conduct regulatory research
• Analyze government reimbursement and assist with provider and payer enrollment
• Manage professional enrollment, facility credentialing and re-credentialing, including CAQH processes
• Lead PHO contract negotiations and planning

You have

• Bachelor’s degree in Finance, Accounting, Business Administration, or related field (Master’s preferred)
• Minimum of 7 years of experience in healthcare reimbursement and managed care – some leadership experience is preferred
• Extensive knowledge of healthcare finance, reimbursement methodologies, and regulatory requirements
• Experience with Soarian, StrataJazz, and other relevant software systems preferred
• Strong analytical, problem-solving, and decision-making skills
• Excellent communication and negotiation abilities
• Demonstrated ability to lead and manage a team effectively

Ready to join our team?

Apply today!

This position is available immediately and we’re excited to welcome passionate individuals who share our commitment to providing exceptional healthcare services.

Scheduled Weekly Hours

40

Travel Requirement

Travel Requirement: Up to 10% travel to on-site locations. Travel is planned in advance whenever possible to support work-life balance.

Benefits

Supporting all aspects of our employees’ wellness – physical, emotional and financial – is a critical component of being a great place to work. With the wide range of benefits and programs available, employees have the resources they need to be well at every stage of life and plan for the future.

Physical Wellness

• We offer quality health, dental, and vision benefits and wellness programs and resources to provide employees access to resources for a healthy lifestyle and help manage health care costs.
• Employees have access to industry-leading leave for new parents.
• A generous earned time plan is offered to all employees - We believe employees need and deserve time away from work to observe holidays, be with family, go on vacation, or simply take care of themselves.

Emotional Wellness

When life gets challenging, employees have access to our Employee Assistance Program for employees and anyone in their household.

Financial Wellness

• An employee discount program is available to all employees for services provided by MaineGeneral Medical Center.
• Tuition Reimbursement is available to all employees to further develop skills and career.
• We offer eligible employees up to 2% of eligible pay in 403(b) company-matching contributions plus another 2% in the 401(a) retirement income plan.
• Three insurance plans are available to protect your family from the sudden loss of income in the event of your death, terminal illness or serious injury from accident.
• We offer both short-term and long-term disability insurance to replace a portion of your income if you become disabled and cannot work for a period of time.

Career Mobility

Helping our employees develop their skills and grow their careers is critical to how we retain our talent and sustain our business. We do this by offering our teammates a variety of leadership-supported programs and learning and development resources for every stage of their professional development. We know that our employees are our most valuable resource – they’re how we grow our business and care for our community.

Equal Opportunity Employer M/F/Vet/Disability Assistive technologies are available. Application assistance for those requesting reasonable accommodation to the career site is available by contacting HR at [phone] .