Director Reimbursement
Raleigh Metro Area, North Carolina
Category: Healthcare
Reference ID: 10064767
Shortcut: http://addisongroup.gosnaphop.com/DkbsnK
Job Title: Director of Reimbursement
Location: Raleigh, NC
Job Type: Full-Time Reports To: CFO / VP of Finance
Compensation: $170,000-$200,000 / year plus a 10% bonus.
Benefits: This position is eligible for medical, health and wellness programs, PTO, tuition reimbursement, and employee discounts.
Position Summary
We are seeking an experienced and strategic Director of Reimbursement to lead all aspects of Medicare and Medicaid cost reporting, governmental reimbursement programs, and regulatory compliance. This senior leadership role is responsible for maximizing appropriate reimbursement, maintaining audit readiness, and guiding the organization through the evolving complexities of cost-based and prospective payment methodologies. The ideal candidate brings deep technical expertise in hospital cost reporting, wage index, DSH calculations, the S-10 worksheet, and Medicare/Medicaid audit management — paired with the ability to lead and develop a high-performing reimbursement team.
Key Responsibilities
Cost Reporting & Medicaid Reimbursement
- Oversee preparation, filing, and settlement of Medicare and Medicaid cost reports (CMS-2552) for all hospital entities
- Manage Medicaid-specific rate setting, supplemental payment programs, and UPL calculations
- Ensure timely and accurate completion of interim and final cost reports, coordinating with external consultants as needed
- Monitor and analyze cost report settlements, reserves, and appeals; maintain documentation to support net revenue reporting
Wage Index & DSH
- Lead the annual wage index process, including occupational mix survey submissions and reclassification/redesignation filings
- Manage DSH calculations, audits, and supplemental payment reconciliations at both the Medicare and Medicaid level
- Identify and pursue wage index improvement opportunities in collaboration with HR and Finance
S-10 / Uncompensated Care
- Direct the preparation and accuracy of the S-10 worksheet to optimize uncompensated care pool distributions
- Maintain robust documentation and audit trails supporting charity care and bad debt classifications per CMS guidance
- Monitor regulatory updates to S-10 methodology and proactively adjust internal processes accordingly
Audit Readiness & Regulatory Compliance
- Serve as the primary point of contact for MAC audits, RAC, MIC, and OIG reviews
- Maintain an audit-ready posture through continuous internal review, documentation standards, and staff training
- Ensure compliance with all CMS regulations, IPPS/OPPS updates, and applicable state Medicaid program requirements
- Manage tentative and no-change settlements and coordinate appeal strategies with legal counsel and external advisors
Leadership & Financial Oversight
- Lead, mentor, and develop a team of reimbursement analysts and specialists
- Partner with Finance, Revenue Cycle, Compliance, and Clinical Operations to align reimbursement strategy with organizational goals
- Provide regular reporting to the CFO and executive leadership on reimbursement reserves, settlements, and risk exposure
Qualifications
Required
- Bachelor's degree in Accounting, Finance, Health Administration, or a related field
- 7–10 years of progressive hospital reimbursement experience, with at least 3 years in a leadership role
- Deep expertise in Medicare/Medicaid cost reporting (CMS-2552), wage index, DSH, and S-10 worksheets
- Proven experience managing MAC, RAC, and other governmental audits through resolution
- Strong working knowledge of IPPS, OPPS, and applicable Medicaid waiver/supplemental payment programs
- Proficiency with cost report preparation software (e.g., Solver, MCM, Cotiviti, or equivalent)
Preferred
- Master's degree (MBA, MHA, or MPA) or CPA licensure
- Experience with multi-entity health systems or academic medical centers
- Familiarity with Epic or enterprise financial systems
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