Director of Reimbursement & Regulatory Analysis

Overview

The Director of Reimbursement & Regulatory Analysis is responsible for overseeing reimbursement and regulatory analysis processes assigned by the Vice President – Regulatory Analysis. This position ensures that the organization complies with Federal and State reimbursement and financial regulatory rules. Position will also advise the organization on reimbursement and on financial regulatory laws and regulations, both proposed and finalized. The Director of Reimbursement & Regulatory Analysis will provide guidance and training to staff.

Responsibilities

- Lead regulatory and reimbursement strategy by managing comment letters, ensuring compliance with federal and state price transparency requirements, and maintaining CDMs.

- Drive operational excellence through automation, process improvement, system optimization, and data-driven reimbursement analysis.

- Develop and implement reimbursement policies, financial strategies, and revenue cycle initiatives that support organizational goals, regulatory compliance, and financial performance.

- Partner with Finance and other stakeholders on forecasting, audits, and strategic planning to strengthen the organization’s overall financial health.

- Monitor healthcare market and regulatory changes, adapting reimbursement strategies to mitigate risk and capitalize on opportunities.

- Build and maintain effective relationships with payors, government agencies, and key stakeholders while communicating complex reimbursement matters to senior leadership.

- Lead, mentor, and develop team members by setting expectations, monitoring performance, and fostering professional growth.

Qualifications

- Bachelor’s degree in finance, Accounting, Healthcare Administration, or a related field. Master’s degree preferred.

- Seven plus years of experience with proven ability in a healthcare reimbursement role with at least five years in a leadership role.

- Experience with electronic health records (EHR) systems (Epic).

- Understand and experience with healthcare CDMs.

- Deep understanding of Medicare/Medicaid regulations, managed care reimbursement, and DRG payment system.

- Understanding of healthcare price transparency rules and regulations.

- Excellent interpersonal and communication skills, oral and written, with all levels of the organization.

- Proficiency in Microsoft Office Suite and cost report software.

- Proven track record of increasing reimbursement rates.

- Excellent analytical and problem-solving skills.

- Proven ability to manage multiple tasks, prioritize, and meet deadlines in a fast-paced environment.

- Proven track record of successfully leading a team to achieve goals and objectives.

- Ability to navigate and adapt to change.