System Director, Reimbursement

Bon Secours Mercy Health

. Lead the reimbursement operating model for the assigned state portfolio and markets .

Posted 9/23/2026full-timeRemote • United StatesLeadWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates extensive expertise in Medicare and Medicaid reimbursement, including cost reporting, payment integrity, and regulatory analysis across various healthcare settings. Proven ability to lead teams, manage complex portfolios, and provide strategic advisory to senior executives while ensuring compliance and quality standards.

Highest-signal resume keywords

Medicare And Medicaid Cost ReportingRegulatory AnalysisLeadership In Multi-Entity EnvironmentsInternal Controls And QA GovernanceAI And Data Science Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Cost ReportingPayment Integrity OversightRegulatory ComplianceFinancial Impact AnalysisReimbursement ForecastingAudit ManagementPerformance MeasuresReimbursement AnalyticsAlgorithmic Bias IdentificationDigital Upskilling

Soft Skills

Strategic AdvisoryCritical ThinkingSynthesis Of Complex IssuesClear CommunicationTeam Leadership

Tools & Technologies

AI ToolsGenAI ToolsPython-Based Analytics LibrariesLow-Code ToolsNo-Code Tools

Certifications & Qualifications

CPAFHFMACRCR

Industry Keywords

Healthcare AdministrationRevenue CycleMedicaid Managed CareAcute CarePost-Acute CareAmbulatory CareBehavioral HealthSpecialty SettingsGovernment Payer Audit340B Compliance

Tech Stack

Tools & technologies

NumpyPandasPython

About the role

Key responsibilities & impact

Lead the reimbursement operating model for the assigned state portfolio and markets
Oversee cost reporting, Medicare and Medicaid payment integrity, regulatory analysis, audits, settlements, and strategic advisory activities
Apply enterprise reimbursement standards and coordinate approved state-specific adaptations
Direct Directors, Managers, Senior Analysts, technical leaders, and matrixed GBS support
Set priorities, allocate resources, and maintain succession and contingency plans
Monitor and model CMS rules, state Medicaid rate changes, and legislative developments
Maintain regulatory calendars and provide financial impact analysis to the VP, Reimbursement and market CFOs
Oversee cost report monitoring, reconciliations, reimbursement positioning, and quarterly CFO reporting
Govern the Medicare and Medicaid cost report lifecycle, filing deadlines, audits, NPRs, reopenings, and appeals
Lead Medicare and Medicaid fee-for-service payment integrity, including audit risk monitoring, self-audits, overpayment identification, repayment governance, and compliance monitoring
Maintain reimbursement forecasting and risk reporting across the assigned state portfolio
Provide executive reporting on forecasts, settlements, filing status, audit exposure, regulatory change, resource risks, controls, and corrective actions
Serve as reimbursement subject matter expert for Revenue Cycle analyses, denial strategies, and projects
Apply reimbursement expertise across acute, post-acute, ambulatory, physician, behavioral health, and specialty settings
Serve as primary reimbursement contact for state presidents, state Finance leadership, and market leaders
Advise on service line development, acquisition due diligence, site-of-care strategy, new programs, and capital project pro formas
Champion AI, GenAI, data science, automation, and digital upskilling for reimbursement analytics and reporting
Oversee stateside-GBS execution, work segmentation, quality standards, acceptance criteria, and escalations
Strengthen internal controls, quality assurance, reconciliations, management reviews, and remediation governance
Build performance-management frameworks and sponsor technology, analytics, workflow, and automation improvements

Requirements

What you’ll need

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, specialized reimbursement matters, and material financial exposure
Demonstrated ability to advise senior executives and CFOs, synthesize complex issues, and present clear recommendations and decisions needed
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, prompt engineering, use-case identification, and the ability to interpret, validate, and explain AI-generated analytical outputs
Ability to identify algorithmic bias and apply critical thinking to technology-produced results before use in regulatory or executive contexts
Experience leading matrixed, shared-services, or geographically distributed teams and driving accountability across organizational boundaries (preferred)
Experience with state Medicaid programs, state-specific supplemental payment structures, and state Medicaid managed care organizations relevant to BSMH's operating states (Ohio, Virginia, Kentucky, South Carolina, Maryland) (preferred)
Master's degree in accounting, finance, business administration, or health care administration (preferred)
CPA, FHFMA, CRCR, or other advanced professional credential (preferred)
Leadership experience in a large multi-state health system (preferred)
Experience governing a global business services or offshore operating model in a reimbursement, finance, or revenue cycle context (preferred)
Experience leading reimbursement technology, workflow, data governance, analytics, or automation initiatives (preferred)
Experience with significant Medicare and Medicaid audits, appeals, regulatory strategy, and executive financial reporting (preferred)
Experience partnering with Legal, Compliance, Pharmacy/340B, Revenue Cycle, or operational teams on government payer audit, overpayment, disclosure, or payment risk matters (preferred)
Experience with Medicare and Medicaid payment integrity programs, including RAC defense, OIG self-disclosures, PERM/CERT exposure modeling, and 340B compliance (preferred)
Citizen digital talent proficiency using low-code or no-code tools, Python-based analytics libraries (NumPy, Pandas, Matplotlib), or similar platforms (preferred)
Experience designing, governing, or overseeing AI/ML or agentic AI workflows in a finance, reimbursement, or revenue cycle context (preferred)
Demonstrated ability to drive digital upskilling across a team, building tiered AI and data science capability (preferred)

Benefits

Comp & perks

Competitive pay
Incentives
Referral bonuses
403(b) with employer contributions (when eligible)
Medical, dental, vision, and 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
Continuing education support