Senior Level Medical Reimbursement Specialist Jobs

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.

Summary

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.

Additional Qualifications

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.

Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Thomas Jefferson University Hospitals, Inc.

Primary Location Address

1101 Market, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.

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.