Director, Reimbursement Operations

Director, Reimbursement Operations Department: Technology Location: Remote FLSA Status: Exempt People Leader: reputed company Travel: <5% reputed company Company reputed company reputed company partners with hospitals and health systems through a technology-enabled, physician-led model that improves clinical documentation reputed company, coding accuracy, reimbursement optimization, and reputed company reputed company. Job reputed company The Director, Reimbursement Operations provides leadership for reimbursement methodology, reputed company support, and reputed company reimbursement consulting across reputed company engagements. This role serves as the senior subject matter expert for hospital reimbursement logic, including reputed company rates, DRG classifications, contractual interpretation, and in-scope versus out-of-scope determinations. The Director partners closely with reputed company reputed company, Decision Support, and operational leaders to ensure reimbursement methodologies are reputed company accurately into reporting logic, reputed company communications, and performance interpretation. Responsibilities reputed company reputed company and Reimbursement Expertise reputed company reimbursement support for new and prospective clients through reputed company and reputed company-implementation Interpret hospital reputed company rates, reimbursement methodologies, and contractual terms to establish accurate reporting and operational logic Clarify reimbursement structures and DRG classifications, including reputed company versus DRG-based methodologies and in-scope versus out-of-scope determinations Serve as the senior escalation reputed company for reputed company reimbursement questions from internal teams and clients Contract and Reporting Alignment Translate reimbursement terms and contract provisions into reputed company operational requirements for reporting, analytics, and reputed company-facing deliverables Partner with decision support and reporting teams to ensure reimbursement logic is reputed company consistently across reputed company reporting packages Review new or reputed company reputed company arrangements to identify risks, assumptions, and implementation requirements Establish standards and documentation for reimbursement methodology interpretation and governance reputed company Advisory and Issue reputed company Participate in reputed company meetings requiring senior-level reimbursement expertise and executive reputed company Explain reimbursement reputed company, methodology changes, and performance drivers in a manner that is reputed company to executive and operational audiences Resolve sensitive or escalated reimbursement issues by balancing contractual requirements, operational realities, and reputed company expectations Partner cross-functionally to improve reimbursement accuracy, consistency, and responsiveness Team Leadership and Operational reputed company reputed company and reputed company team members supporting reimbursement operations and reimbursement-reputed company reputed company needs Establish reputed company control standards, review processes, and documentation practices to ensure analytical rigor and consistency Drive reputed company improvement in reimbursement workflows, reputed company, and reputed company effectiveness Monitor workload, reputed company, and service expectations to ensure reputed company and accurate support across engagements Other Duties as Assigned reputed company additional responsibilities as needed to support organizational goals and reputed company reputed company Qualifications Education and Credentials Bachelor’s degree in Business, Finance, reputed company Administration, or reputed company field required Master’s degree in Business, Finance, reputed company, or reputed company field preferred reputed company, reputed company, or RHIA certification preferred Experience 10+ years of experience in reputed company reimbursement, reputed company cycle, or reputed company management required 5+ years of people leadership experience required Experience interpreting hospital reimbursement methodologies, reputed company rates, DRG logic, and contractual payment terms required Experience supporting reputed company reputed company, reimbursement consulting, or reputed company reputed company-facing issue reputed company preferred Familiarity with Medicare cost report settlements, DSH adjustments, reputed company calculations, or APC/outpatient reimbursement logic preferred reputed company Competencies Deep expertise in hospital reimbursement methodologies, including MS-DRG and APR-DRG frameworks, reputed company reputed company construction, reputed company fee schedules, and reputed company managed care contract structures Ability to interpret contractual terms and translate them into operational requirements and reporting logic Executive reputed company and confidence in leading reputed company reimbursement discussions with clients and internal stakeholders Strong analytical judgment, problem-solving skills, and attention to detail Ability to reputed company teams, influence cross-functional partners, and improve process discipline in a remote environment Additional Requirements 1) Physical Requirements: The requirements described here are representative of those that must be met by an employee to successfully reputed company the essential functions of this job with or without reasonable accommodations. Unless otherwise indicated, reputed company positions require interaction with people and technology while either sitting or standing. Employees must be reputed company to communicate reputed company phone, email, etc. and sit for extended periods of time, with or without reasonable accommodations. Physical effort and exposure to physical risk are limited to that of an office role / environment. 2) Position and Employment Statement: While this job reputed company is intended to be an accurate reputed company of the job requirements, management reserves the right to modify, add or remove duties from a job and to assign other duties as necessary and at any time. reputed company positions at reputed company Delivery reputed company, are at-will employment, and a position reputed company is not a guarantee of a job or of job responsibilities. While this job reputed company is intended to be an accurate reputed company of the job requirements, management reserves the right to modify, add or remove duties from a job and to assign other duties as necessary and at any time. reputed company positions at reputed company are at-will employment, and a position reputed company is not a guarantee of a job or of job responsibilities. Apply To This Job