<p>Job Description</p> <p>Job Title: Centralus Reimbursement Optimization Director</p> <p>Department: Reimbursement</p> <p>Reports To: Chief Financial Officer</p> <p>Job Summary: The Centralus Reimbursement Optimization Director is a strategic leader responsible for advancing reimbursement and revenue cycle performance across the healthcare organization. This role drives continuous improvement in collections, payer reimbursement accuracy, and overall financial integrity. Working closely with clinical, operational, and revenue cycle leaders, the Director identifies process gaps, conducts comprehensive root-cause analyses, and leads the development, implementation, and ongoing evaluation of optimized solutions. This position ensures that reimbursement practices remain compliant, efficient, and aligned with organizational goals, ultimately supporting sustainable financial health and high-quality patient care.</p> <p>Areas for Analysis(at the direction of the CFO):</p> <p>Leadership and Strategy:</p> <ul> <li>Analyze KPI"s for the reimbursement function across the healthcare system (Revenue Cycle Meetings, Denial Committee, Reg Committee, etc.). </li><li>Review oversight of Patient Access / Registration and Authorization business units ensuring teams are performing at top tier per EPIC. </li><li>Collaborate with executive leadership to align reimbursement strategies with organizational goals. </li></ul> <p>Payor Contracting:</p> <ul> <li>Review current mechansims in place to assure payments are made in compliance with payer and government contracts - </li><li>Review analysis of contract terms, payer performance, and reimbursement methodologies to identify and maximize revenue opportunities. </li></ul> <p>Financial Performance:</p> <ul> <li>Analyze reimbursement trends and financial data to identify opportunities for improving revenue capture. </li><li>Develop and monitor key performance indicators (KPIs) related to reimbursement and revenue cycle management. </li><li>Prepare reports and presentations for executive leadership on reimbursement performance and financial impact. </li></ul> <p>Policy and Compliance:</p> <ul> <li>Ensure adherence to payer policies, coding guidelines, and regulatory requirements. </li><li>Develop and implement internal policies and procedures to maintain compliance and optimize reimbursement as regulations change. </li><li>Conduct audits and assessments to identify areas for improvement and ensure adherence to best practices. </li></ul> <p>Collaboration and Communication:</p> <ul> <li>Work closely with clinical, provider, financial, and administrative teams to address reimbursement-related issues and enhance processes. </li><li>Facilitate training and education for providers, directors and managers on reimbursement processes and changes in regulations. </li><li>Serve as a liaison between the organization and external payers or regulatory bodies. </li></ul> <p>Technology and Innovation:</p> <ul> <li>Evaluate and implement technology solutions to streamline reimbursement processes and improve efficiency. </li><li>Stay current with industry trends, changes in reimbursement policies, and emerging technologies. </li></ul> <p>Job Requirements:</p> <p>Education:</p> <ul> <li>Bachelor's degree in Finance, Healthcare Administration, Business Administration, or a related field. Master's degree preferred. </li></ul> <p>Experience:</p> <ul> <li>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 </li></ul> <p>Skills & Abilities:</p> <p>Knowledge: In-depth understanding of reimbursement methodologies, payer policies, and regulatory requirements. Familiarity with electronic health record (EHR) systems and revenue cycle management software.</p> <p>Skills: Strong analytical and problem-solving skills, excellent communication and interpersonal abilities, and proven leadership capabilities.</p> <ul> <li>Certifications: Relevant certifications (e.g., Certified Revenue Cycle Professional (CRCP), Certified Professional Coder (CPC)) are a plus. </li></ul> <p>Licensure:</p> <ul> <li>n/a </li></ul> <p>Physical Requirements:</p> <ul> <li>This position may require occasional travel to various facilities or locations. </li><li>Ability to work in a hybrid role of remote work with required quarterly on site visits. </li></ul>