[Hiring] System Director, Reimbursement @Mercy Health BSMH

Role Description

Leads an assigned state portfolio within the enterprise Reimbursement function, operating at the State/Market level of the BSMH Operating Model as the enterprise reimbursement point of contact for assigned state and market leadership. Directly accountable for assigned reimbursement workstreams across the full reimbursement value chain — including cost reporting, Medicare and Medicaid payment integrity, regulatory analysis, audit defense, settlement, and strategic advisory.

• Collaborates closely with Revenue Cycle, Finance, Legal, Compliance, and operational partners to protect reimbursement yield and ensure defensible reimbursement outcomes.
• Applies enterprise reimbursement standards as the default; identifies and coordinates state-specific adaptations within approved governance.
• Accountable for assigned hospitals, markets, provider types, and reimbursement workstreams within the state portfolio.
• Serves as a subject matter expert for designated specialized reimbursement areas.
• Provides leadership to Directors, Managers, and Senior Analysts.
• Ensures executive and CFO-facing transparency for the assigned state portfolio.
• Escalates material risks across the broader reimbursement operating model.

Qualifications

• Bachelor's degree in accounting, finance, business administration, health care administration, or a related field, or an equivalent combination of education and directly relevant experience.
• Extensive progressive hospital reimbursement experience, including leadership accountability for Medicare and Medicaid cost reporting, settlements, regulatory analysis, audits, and complex reimbursement matters in a multi-entity environment.
• Demonstrated experience with complex Medicare and Medicaid reimbursement matters, including cost reporting, payment integrity oversight, regulatory analysis, audits, appeals, reserves, or related reimbursement analytics.
• Working knowledge of hospital reimbursement across multiple care settings, including acute, post-acute, ambulatory, and/or physician settings.
• Demonstrated experience leading leaders and managing broad assigned portfolios with competing regulatory deadlines.
• Demonstrated ability to advise senior executives and CFOs, synthesize complex issues, and present clear recommendations.
• Demonstrated experience establishing enterprise internal controls, QA governance, standardized processes, performance measures, and audit-ready documentation.
• Foundational digital literacy, including working familiarity with AI and GenAI tools.
• Experience leading matrixed, shared-services, or geographically distributed teams (preferred).

Requirements

• Experience with state Medicaid programs, state-specific supplemental payment structures, and state Medicaid managed care organizations relevant to BSMH's operating states.
• Master's degree in accounting, finance, business administration, or health care administration.
• CPA, FHFMA, CRCR, or other advanced professional credential.
• Leadership experience in a large multi-state health system.
• Demonstrated experience governing a global business services or offshore operating model.
• Experience leading reimbursement technology, workflow, data governance, analytics, or automation initiatives.
• Experience with significant Medicare and Medicaid audits, appeals, regulatory strategy, and executive financial reporting.
• Experience partnering with Legal, Compliance, Pharmacy/340B, Revenue Cycle, or operational teams on government payer audit matters.
• Citizen digital talent proficiency — ability to build and customize data science and analytics solutions.

Benefits

• Competitive pay, incentives, referral bonuses and 403(b) with employer contributions (when eligible).
• Medical, dental, vision, prescription coverage, HSA/FSA options, life insurance, mental health resources and discounts.
• Paid time off, parental and FMLA leave, short- and long-term disability, backup care for children and elders.
• Tuition assistance, professional development and continuing education support.
• Benefits may vary based on the market and employment status.