AVP, Reimbursement - Jefferson Health

About the role

Number of Positions In Requisition

1

Job Details

The Associate Vice President of Reimbursement leads the organization's government reimbursement strategy, regulatory reporting, and payment optimization initiatives across the enterprise. The position oversees the accurate and timely preparation, review, certification, and filing of Medicare and Medicaid cost reports; directs responses to audits, reopenings, appeals, and regulatory inquiries; advises senior leadership on reimbursement risks and opportunities; and develops strategies that strengthen financial performance, regulatory compliance, and consistency across hospitals, regions, and affiliated entities.

Job Duties

• Lead enterprise government reimbursement strategy, including the identification, evaluation, and realization of Medicare and Medicaid payment opportunities across hospitals, regions, and affiliated entities.
• Oversee the accurate and timely preparation, review, certification, and filing of Medicare and Medicaid cost reports and other required government submissions, supported by effective controls and documentation.
• Direct cost-report audits, reopenings, appeals, and settlement activities, ensuring that organizational positions are timely, well supported, defensible, and compliant with applicable regulations.
• Establish reimbursement policies, procedures, governance standards, and internal controls that promote consistent, reliable reporting across assigned entities.
• Monitor and interpret proposed and final Medicare and Medicaid regulations, quantify financial and operational impacts, and advise senior leadership on risks, opportunities, and recommended actions.
• Provide subject-matter leadership for disproportionate share hospital payments, indirect and direct graduate medical education, wage index, geographic reclassification, value-based purchasing, and other government payment methodologies.
• Direct organizational participation in state supplemental payment programs, including strategy development, data validation, submission oversight, reconciliation, and compliance monitoring.
• Develop reimbursement assumptions for the annual operating budget, long-range plan, financial forecasts, and period-end close; evaluate variances and recommend appropriate financial adjustments or reserves.
• Partner with finance, accounting, revenue cycle, legal, compliance, operations, clinical leadership, and external advisors to resolve complex reimbursement matters and support enterprise initiatives, integrations, and transactions.
• Represent the organization in interactions with governmental agencies, auditors, contractors, consultants, and other external stakeholders, as appropriate.
• Build and lead a high-performing reimbursement team by setting clear expectations, delegating effectively, managing performance, providing constructive feedback, and creating development and succession opportunities.

Minimum Qualifications

• Bachelor’s Degree in accounting, finance, health administration, or a related field.
• 10 years of progressively responsible hospital reimbursement experience, including responsibility for complex Medicare and Medicaid cost reporting, audits, settlements, and payment analysis.
• Prior experience leading professional reimbursement or finance staff, including responsibility for goal setting, delegation, staff development, succession planning, and performance management.
• Experience directing complex financial close, audit, budgeting, forecasting, regulatory reporting, and cross-functional decision-support processes.
• Comprehensive knowledge of Medicare and Medicaid regulations, cost-reporting requirements, and hospital payment methodologies.
• Demonstrated ability to establish and maintain effective reimbursement policies, procedures, governance standards, internal controls, and supporting documentation.
• Ability to interpret complex regulations, assess financial and operational effects, formulate defensible positions, and translate findings into actionable recommendations.
• Strong executive communication and presentation skills, including the ability to explain complex financial matters clearly to senior leaders, auditors, operational partners, and other stakeholders.
• Strong project-management and change-leadership skills, with the ability to guide cross-functional initiatives, organizational integrations, and process standardization.
• Ability to manage multiple priorities, exercise sound judgment, and deliver accurate, timely results in a complex and changing regulatory environment.
• Advanced proficiency in spreadsheet modeling, reimbursement systems, financial reporting platforms, and data-analysis tools, with the ability to convert complex data into actionable insights.
• Ability to build effective relationships, influence decisions, and collaborate across finance, operations, clinical, legal, compliance, and executive leadership functions

Physical Demands

Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts.

Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

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