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Day - 08 Hour (United States of America)

This is a Stanford Health Care job.

A Brief Overview

The Director of Reimbursement is a key leadership role within the Controller's Office, responsible for overseeing the organization's compliance reporting and non-patient services reimbursement activities. This role ensures the timely and accurate preparation and submission of financial and regulatory reports to government agencies, including but not limited to:

•Medicare and Medi-Cal cost reports

•Financial disclosures to the Department of Health Care Access and Information (HCAI)

In addition, the Director of Reimbursement oversees the organization's responses to government audits and inquiries, ensuring full compliance and clear communication with regulatory agencies. The role also ensures the accuracy of invoicing for non-patient related services provided to external customers. The Director of Reimbursement plays a critical role in shaping the financial integrity of the organization. As a senior member of the team, this individual actively contributes to process improvement initiatives, drives innovation in financial systems, and fosters a culture of change, accountability, and continuous improvement.

Locations

Stanford Health Care

What you will do

+ Government Payor Reporting & Reimbursement

+ Ensure timely and accurate filing of annual government cost reports, including Medicare, Medi-Cal, and HCAI submissions.

+ Maintain comprehensive knowledge of federal and state reimbursement laws and regulations to maximize reimbursement.

+ Develop, implement, and maintain internal policies and procedures to ensure complete and accurate capture of all legitimate reimbursement opportunities.

+ Oversee Medicare and Medi-Cal audit processes, addressing inquiries and pursuing appeals or litigation when necessary (e.g., CMS disputes).

+ Review third-party contractual allowances, settlements, and variances (actual vs. budget) to support accurate financial reporting.

+ Participate in the annual budget development process by providing detailed analysis and projections related to government payor net income.

+ Prepare and respond to year-end financial audits, specifically related to third-party liabilities and balance sheet reserves.

+ Serve as the subject matter expert on regulatory compliance reporting, including Medicare and Medi-Cal cost reports

+ Lead alignment of compliance reporting processes across SHC-related entities and partner organizations.

+ Continuously assess and improve reimbursement and reporting processes to increase efficiency, accuracy, and scalability.

+ Non-Patient Care Services Receivable

+ Oversee invoicing, contract compliance, and financial administration for non-patient care service agreements, such as:

+ Graduate Medical Education (GME) affiliation agreements

+ Physician outreach and other academic/clinical support contracts

+ Coordinate with internal department, affiliated entities, and external partners to ensure contract terms are accurately maintained and executed.

+ Ensure obligations are properly managed and tracked within the Workday customer management model.

+ Serve as the subject matter expert for the Workday customer management model, assisting in the development and enhancement of business process workflows.

+ Participate in system testing and user acceptance activities related to workflow improvements and updates within Workday.

+ Leadership, Collaboration & Strategic Support

+ Promote a culture of learning, continuous, improvement, and compliance across the reimbursement function.

+ Mentor and develop staff to deepen their knowledge of reimbursement regulations, reporting, and methodologies.

+ Support talent development and succession planning by identifying growth opportunities and preparing high-potential staff for future leadership roles.

+ Work cross-functionally with leaders and staff from various departments and backgrounds to address complex reimbursement and compliance matters.

+ Communicate complex, variable reimbursement and regulatory issues in clear, concise narratives to support strategic decision-making.

+ Provide analytical and subject matter support to broader strategic and financial initiatives as needed.

Education Qualifications

+ Bachelor’s Degree in business, finance, health or public administration or a related field.

+ Master’s Degree in business, health or public administration, management, or related field strongly preferred.

Experience Qualifications

+ Minimum ten (10) years of progressively responsible and directly related work experience required.

+ 10+ years of performing duties similar to those described in essential functions of the description. Preferred experience as an auditor working with CMS or a CMS Medicare Auditor Contractor and strong familiarity with Medicare and Medicaid regulations.

Required Knowledge, Skills and Abilities

+ Advanced knowledge of CMS and state Medicaid reimbursement principles and practices.

+ Multi-year skill and experience managing business processes for organizations using a major ERP system.

+ Ability to communicate complex concepts in simple form to non-finance users to understand the appropriate use and limits of the information provided.

+ Ability to communicate and present complex issue with government agencies to resolve audit issues.

+ Ability to manage, organize, prioritize, multi-task and adapt to changing priorities.

+ Ability to foster effective working relationships and build consensus.

+ Ability to partner in the development and achievement of goals, vision, and overall direction of the Controller’s Office at Stanford Health Care.

+ Ability to provide clear and concise information/presentations to Senior Executive Team.

+ Ability to develop strong team culture and working relationship with colleagues across the health system.

+ Ability to drive a culture of proactive, integrated, responsive, high quality financial analysis.

+ Ability to effectively manage deliverables and timelines.

Preferred Knowledge, Skills and Abilities

+ Ability to develop strong team culture and working relationship with colleagues across the health system

+ Ability to drive a culture of proactive, integrated, responsive, high quality financial analysis

+ Ability to effectively manage deliverables and timelines

Licenses and Certifications

+ CPA - Certified Public Accountant preferred

+ HFMA - Certified Rev Cycle Rep (CRCR) preferred

Physical Demands and Work Conditions

Blood Borne Pathogens

+ Category II - Tasks that involve NO exposure to blood, body fluids or tissues, but employment may require performing unplanned Category I tasks

These principles apply to ALL employees:

SHC Commitment to Providing an Exceptional Patient & Family Experience

_Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery._

_You will do this by executing against our three experience pillars, from the patient and family’s perspective:_

+ Know Me: Anticipate my needs and status to deliver effective care

+ Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health

+ Coordinate for Me: Own the complexity of my care through coordination

Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in** **all of** **its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.

Base Pay Scale: Generally starting at $89.01 - $117.94 per hour

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.

At Stanford Health Care, we seek to provide patients with the very best in diagnosis and treatment, with outstanding quality, compassion and coordination. With an unmatched track record of scientific discovery, technological innovation and translational medicine, Stanford Medicine physicians are pioneering leading edge therapies today that will change the way health care is delivered tomorrow.

As part of our spirit of discovery, we also leverage our deep relationships with luminary Silicon Valley companies to develop new ways to deliver preeminent patient care.

Learn about our awards (https://stanfordhealthcare.org/about-us/awards.html) and significant events (https://stanfordhealthcare.org/about-us/our-history.html) .