Job Purpose:

PruittHealth is seeking a detail-oriented and experienced Reimbursement Director to lead and oversee reimbursement activities within the organization’s finance division. This role is critical to ensuring compliance with state and federal regulations, optimizing reimbursement processes, and managing reporting related to reimbursement. The ideal candidate will have a strong background in healthcare third party documentation, Medicare and Medicaid reimbursement and managing bad debt claims.

Key Responsibilities:

·         Direct all aspects of reimbursement operations, reporting, rate setting, and Medicare bad debt review for PruittHealth’s healthcare facilities and services.

·         Ensure compliance with federal and state regulations regarding Medicare, Medicaid, and other third-party payers. Maintain up-to-date knowledge of changes in reimbursement regulations.

·         Manage the preparation, submission, and review of accurate and timely Medicare and Medicaid reports. Analyze results and implement strategies for optimization.

·         Identify opportunities to enhance reimbursement outcomes through effective analysis and reporting. Collaborate with executive leadership to align reimbursement strategies with organizational goals.

·         Lead and mentor a team of reimbursement professionals, fostering a culture of collaboration, accountability, and continuous improvement.

·         Coordinate with internal and external resources on reimbursement-related audits, ensuring timely resolution of any findings or discrepancies.

·         Work closely with operations, accounting, and clinical teams to support financial objectives and optimize reimbursement opportunities.

Qualifications

Qualifications - External

Minimum Education Required:

Bachelor’s degree in Accounting, Finance, Healthcare Administration, or a related field (Master’s degree preferred).

Minimum Experience Required:

Minimum of 5–7 years of experience in healthcare reimbursement, preferably in a long-term care or senior living setting.

Minimum Licensure/Certification Required by Law:

Additional Qualifications: (Preferred qualifications)

·         Proven track record of managing Medicare and Medicaid cost reporting and audits.

·         Familiarity with CMS regulations and reimbursement models.

·         Experienced with collection write off tool for Private Medicare bad debt review

·         MatrixCare billing-related data and reports experience

·         MatrixCare Claims Manager or the equivalent for accessing UB04s experience

·         PeopleSoft Finance reporting and reconciliation experience.

Family Makes Us Stronger. Our family, your family, one family. Committed to loving, giving, and caring. United in making a difference.

We are eager to connect with you! Apply Now to get started at PruittHealth!

As an Equal Employment Opportunity employer, all qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, disability, or veteran status.