Senior Director, System Reimbursement

Role Overview

• Provides enterprise-wide strategic and operational leadership for reimbursement and patient service revenue recognition ensuring alignment with regulatory requirements
• Ensures the integrity, completeness, and accuracy of net patient service revenue, and third-party settlement estimates, in accordance with GAAP
• Oversees methodologies supporting financial estimates and continuously monitors variance, hindsight analysis, and emerging trends
• Leads the development of advanced analytics and tools (e.g., dashboards, predictive models) that provide actionable insights into reimbursement trends, denial drivers, and the financial impact of value-based and quality reimbursement programs
• Proactively monitors and interprets evolving federal and state reimbursement regulations and payer methodologies, translating changes into actionable strategies that maintain full regulatory compliance
• Synthesizes complex regulatory changes and reimbursement dynamics into clear, executive-level insights, including quantified financial impacts, risks, and recommended strategic responses for senior leadership and governance committees
• Oversees the timely and accurate completion and submission of all third-party cost reports and other reimbursement reports or correspondence which may be required by third-party payors and/or government agencies
• Oversees all interactions with Medicare Administrative Contractors and other payors, including audit management, settlement reviews, and appeal strategies, ensuring optimal financial outcomes and defensible positions
• Directs the research and accumulation of data for filing of formal appeals, re-opening requests, exception requests to rates or payment methodologies to support the Geisinger's position on governmental and third-party regulations
• Ensures compliance with all applicable federal and state reimbursement regulations, including CMS rules, Medicare/Medicaid payment methodologies, and related billing and documentation requirements across hospital, professional, and academic entities
• Provides strategic and technical guidance on graduate medical education reimbursement, including modeling, affiliation agreements, and compliance with CMS resident cap regulations
• Serves as a strategic advisor in evaluating proposed regulatory and legislative changes, partnering with Government Relations to influence policy through data-driven analysis, formal comment letters, and industry engagement
• Builds and develops a high-performing team through strategic talent management, succession planning, and a culture of accountability, continuous improvement, and cross-functional collaboration
• Champions the adoption and optimization of reimbursement and revenue analytics technologies, including automation tools and advanced modeling platforms, to improve accuracy, efficiency, and scalability
• Provides subject matter expertise on reimbursement and revenue recognition implications for mergers, acquisitions, affiliations, and new business models, including due diligence, integration planning, and pro forma financial impact analysis

Requirements

• Bachelor's Degree
• (Required)
• Master's Degree
• (Preferred)
• Minimum of 8 years-Finance (Required)
• Minimum of 5 years-Managerial/Supervisory (Required)
• Skills: Analytical Thinking, Communication, Computer Literacy, Healthcare Industry, Organizing, Teamwork

Benefits

• healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners
• atmosphere of collaboration, cooperation and collegiality