System Director, Reimbursement

RiseMe; New Jersey; Hybrid; USD 180,000 - 260,000; Full time

Job summary

Bon Secours Mercy Health is seeking a System Director of Reimbursement to lead the state portfolio and its markets, ensuring cost reporting accuracy, Medicare/Medicaid integrity, and compliance. The role collaborates with Revenue Cycle, Finance, Legal and Compliance to protect reimbursement yield and present transparent CFO-facing insights.

The position oversees a range of reimbursement workstreams, including regulatory analysis, settlements, audits, and strategic advisory, with executive

Responsibilities

• Lead the reimbursement operating model for the assigned state portfolio and markets, driving cost reporting, CMS/Medicaid integrity, regulatory analysis, audits, settlements and strategic advisory.
• Provide proactive regulatory and financial impact analyses to senior leaders and ensure timely action planning across cross-functional partners.

Job description

Thank you for considering a career at Bon Secours Mercy Health!

Scheduled Weekly Hours: 40

Work Shift: Days (United States of America)

SYSTEM DIRECTOR REIMBURSEMENT: REMOTE

Leads an assigned state portfolio within the enterprise Reimbursement function, operating at the State/Market level of the BSMH Operating Model as the enterprise reimbursement point of contact for assigned state and market leadership. Directly accountable for assigned reimbursement workstreams across the full reimbursement value chain — including cost reporting, Medicare and Medicaid payment integrity, regulatory analysis, audit defense, settlement, and strategic advisory — and collaborates closely with Revenue Cycle, Finance, Legal, Compliance, and operational partners to protect reimbursement yield and ensure defensible reimbursement outcomes across the assigned state portfolio. Applies enterprise reimbursement standards as the default; identifies and coordinates state-specific adaptations within approved governance where the assigned state's regulatory environment, payer landscape, or operational requirements necessitate them. The System Director is accountable for assigned hospitals, markets, provider types, and reimbursement workstreams within the state portfolio — including related quality, deadline, control, and stakeholder outcomes — and serves as a subject matter expert for designated specialized reimbursement areas. The System Director provides leadership to Directors, Managers, and Senior Analysts, supports enterprise standards and controls, ensures executive and CFO-facing transparency for the assigned state portfolio, and escalates material risks across the broader reimbursement operating model.

Essential Functions:

Reimbursement Operating Model Leadership

Lead the reimbursement operating model for the assigned state portfolio and its markets — ensuring direct accountability for assigned cost reporting, Medicare and Medicaid payment integrity, regulatory analysis, audit, settlement, and strategic advisory activities, in collaboration with Revenue Cycle, Finance, Legal, Compliance, and assigned state and market operational partners. Apply enterprise reimbursement standards as the default across the assigned state portfolio; identify and coordinate state-specific adaptations within approved governance where regulatory, payer, or operational requirements of the assigned state market necessitate them, and elevate exception requests and novel positions to the VP, Reimbursement. Direct Directors, Managers, Senior Analysts, and technical leaders responsible for the assigned state portfolio and matrixed GBS support. Set priorities, allocate resources, manage spans of responsibility, and maintain succession and contingency plans.

Reimbursement Policy and Rate Intelligence

Monitor and model the impact of proposed and final CMS rules, state Medicaid rate changes, and legislative developments on the assigned state portfolio. Provide proactive financial impact analysis to the VP, Reimbursement and assigned market CFOs before rules are finalized, and ensure regulatory change is translated into reimbursement, cost report, and cross-functional action planning with appropriate lead time. Maintain a regulatory calendar covering applicable Medicare and Medicaid payment updates, state Medicaid program changes, and state-specific reporting deadlines. Monitor state hospital association communications and state-level legislative activity as it affects reimbursement for the assigned state portfolio.

Cost Report Monitoring and Reimbursement Positioning

Oversee routine monitoring of key reimbursement drivers for the assigned state portfolio, including cost report statistical basis, GL-to-cost-report mapping, DSH and GME positions, wage index data, and interim settlement projections. Maintain a defined monthly reconciliation cadence across core monitoring streams — statistical basis, cost center and GL, DSH/GME and special payment, and interim payment and settlement projection — and ensure quarterly CFO reporting to assigned market and hospital CFOs reflects current reimbursement positions with timely escalation of material changes or risks to the VP, Reimbursement.

Cost Report Lifecycle Governance

Oversee the assigned-portfolio cost report lifecycle and integrated deadline calendar, including Medicare and Medicaid cost reports across all applicable care settings, provider ownership, risk stratification, production waves, review gates, approved filing authority, audit response deadlines, and executive escalation. Provide strategic oversight of Medicare and Medicaid cost reports, home-office cost statements, DSH, S-10, SSI, GME/IME, wage index, bad debts, rural reimbursement, supplemental payment programs, third-party reserves, interim rates, audits, NPRs, reopenings, and appeals, as applicable to the assigned portfolio and designated subject matter expertise.

Medicare and Medicaid Payment Integrity

Lead Medicare and Medicaid payment integrity oversight for the assigned state portfolio, including proactive audit risk monitoring, self-audit protocols, government payer payment accuracy analysis, overpayment identification and repayment governance, and regulatory compliance monitoring across applicable Medicare and state Medicaid fee-for-service programs. Partner with Legal, Compliance, Pharmacy, and operational owners when issues require interpretation, corrective action, repayment assessment, or disclosure consideration, maintaining direct accountability for reimbursement-related analysis, documentation, and escalation. Payment integrity accountability is limited to Medicare and Medicaid fee-for-service programs.

Reimbursement Yield and Financial Visibility

Maintain consolidated reimbursement forecasting and risk reporting for the assigned state portfolio across Medicare FFS, state Medicaid FFS, and government-payer workstreams, including material reimbursement risks, quality-linked payment program exposure, regulatory impacts, and cost report settlement projections. Provide the VP, Reimbursement and state Finance leadership with consolidated, decision-ready reporting on reimbursement forecasts, settlements, filing status, audit exposure, regulatory change, resource risks, control performance, and corrective actions. Establish the executive communication standard for the assigned state portfolio, ensuring Directors, Managers, and supporting Senior Analysts contribute to proactive, concise, and financially focused summaries for assigned market and hospital CFOs.

Revenue Cycle Collaboration

Serve as the reimbursement subject matter expert in joint root cause analyses, denial strategy reviews, and Revenue Cycle projects as assigned or requested. Ensure reimbursement monitoring findings, cost report statistical variances, and government payer reimbursement issues are communicated to Revenue Cycle leadership and vendor governance partners with documented root cause, financial impact, and resolution tracking based on materiality and urgency. Align reimbursement positions with Revenue Cycle leadership and vendor governance partners as needed on matters affecting cost report statistical integrity, including payer identification accuracy, Medicaid day capture, and value and condition code accuracy.

Continuum-Wide Reimbursement Expertise

Apply deep reimbursement expertise to assigned provider types and workstreams across acute, post-acute, ambulatory, physician, behavioral health, and specialty settings within the assigned state portfolio. Maintain sufficient working knowledge of applicable payment systems across assigned care settings to identify reimbursement implications, coordinate with subject matter experts, and elevate site-of-care and care transition issues as appropriate.

State Leadership Partnership

Serve as the enterprise Reimbursement function's primary point of contact for the assigned State President, state Finance shared services leadership, and assigned market leaders. Provide reimbursement subject matter expertise to state leadership on matters affecting reimbursement yield, regulatory compliance, and financial planning for the assigned state portfolio. Participate in state-level forums, planning processes, and cross-functional initiatives as the reimbursement representative, ensuring enterprise reimbursement standards are understood and applied across the assigned state's operational environment. Monitor state Medicaid agency communications, state hospital association activity, and state-level legislative developments that affect the assigned state portfolio and elevate material items to the VP, Reimbursement.

Strategic Advisory

Serve as a reimbursement subject matter authority for assigned state service line development, acquisition due diligence, site-of-care strategy, new program establishment, and capital project pro formas. Ensure reimbursement implications are identified and modeled before strategic decisions are finalized. Coordinate responses to significant Medicare Administrative Contractor or state Medicaid agency matters within the assigned state portfolio, and align reimbursement positions with Legal, Compliance, Government Relations, Accounting, FP&A, Revenue Cycle, and external advisors.

Digital Literacy and AI-Enabled Reimbursement Analytics

Champion the adoption of AI, GenAI, and data science tools within the assigned state portfolio to improve financial visibility, monitoring accuracy, and analytical productivity. Apply foundational GenAI skills — including prompt engineering, use-case identification, and GenAI output validation — to