Centralus Senior Director of Reimbursement Optimization

Centralus Senior Director of Reimbursement Optimization

 Leadership and Strategy:

• Analyze KPI"s for the reimbursement function across the healthcare system (Revenue Cycle Meetings, Denial Committee, Reg Committee, etc.).
• Review oversight of Patient Access / Registration and Authorization business units ensuring teams are performing at top tier per EPIC.
• Collaborate with executive leadership to align reimbursement strategies with organizational goals.

 Payor Contracting:

• Review current mechansims in place to assure payments are made in compliance with payer and government contracts -
• Review analysis of contract terms, payer performance, and reimbursement methodologies to identify and maximize revenue opportunities.

 Financial Performance:

• Analyze reimbursement trends and financial data to identify opportunities for improving revenue capture.
• Develop and monitor key performance indicators (KPIs) related to reimbursement and revenue cycle management.
• Prepare reports and presentations for executive leadership on reimbursement performance and financial impact.

 Policy and Compliance:

• Ensure adherence to payer policies, coding guidelines, and regulatory requirements.
• Develop and implement internal policies and procedures to maintain compliance and optimize reimbursement as regulations change.
• Conduct audits and assessments to identify areas for improvement and ensure adherence to best practices.

 Collaboration and Communication:

• Work closely with clinical, provider, financial, and administrative teams to address reimbursement-related issues and enhance processes.
• Facilitate training and education for providers, directors and managers on reimbursement processes and changes in regulations.
• Serve as a liaison between the organization and external payers or regulatory bodies.

 Technology and Innovation:

• Evaluate and implement technology solutions to streamline reimbursement processes and improve efficiency.
• Stay current with industry trends, changes in reimbursement policies, and emerging technologies.

• This position may require occasional travel to various facilities or locations.
• Ability to work in a hybrid role of remote work with required quarterly on site visits.

• Bachelor's degree in Finance, Healthcare Administration, Business Administration, or a related field. Master's degree preferred.

• Minimum of 7-10 years of experience in healthcare reimbursement, with at least 3-5 years in a leadership role within a healthcare or related setting

 Knowledge: In-depth understanding of reimbursement methodologies, payer policies, and regulatory requirements. Familiarity with electronic health record (EHR) systems and revenue cycle management software.

 Skills: Strong analytical and problem-solving skills, excellent communication and interpersonal abilities, and proven leadership capabilities.

• Certifications: Relevant certifications (e.g., Certified Revenue Cycle Professional (CRCP), Certified Professional Coder (CPC)) are a plus.

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