What are the responsibilities and job description for the Director of Reimbursement & Regulatory Compliance position at Golden Valley Memorial Healthcare?
Job Description:
The Director of Reimbursement & Regulatory Compliance is responsible for managing all aspects of Medicare and Medicaid cost reporting, Disproportionate Share Hospital (DSH) funding, and regulatory changes affecting reimbursement for a Sole Community Rural Hospital (SCH) and its provider-based clinics. This role ensures compliance with federal and state regulations while developing financial strategies to optimize hospital and clinic reimbursement.
Responsibilities:
Reimbursement & Financial Reporting
Work with external auditors to prepare, submit, and analyze Medicare and Medicaid cost reports for the hospital and provider-based clinics. Ensure the hospital maintains Sole Community Hospital (SCH) designation benefits and meets eligibility requirements. Oversee DSH and Uncompensated Care reporting, ensuring accurate documentation and maximizing financial recovery. Monitor and manage rural health clinics (RHC) and provider-based billing to ensure compliance and optimal reimbursement. Lead financial modeling and forecasting for reimbursement impact assessments.
Legislative & Regulatory Compliance
Track federal and state regulatory changes affecting hospital and clinic reimbursement, including 340B, Medicaid, and Medicare payment policies. Advocate for hospital interests by collaborating with state hospital associations, legislators, and industry groups on rural hospital funding issues. Ensure compliance with Medicare Bad Debt reporting, wage index adjustments, and other reimbursement-related regulations.
Audit & Risk Management
Serve as the point of contact for cost report audits, Medicaid DSH audits, and other financial compliance reviews.Implement internal controls and audit strategies to reduce financial risk.Work with external auditors and consultants to support reimbursement initiatives.
Operational & Strategic
Collaboration Partner with hospital leadership, CFO, revenue cycle, and compliance teams to develop strategies for financial sustainability.Provide education to internal teams on reimbursement trends, rural hospital policy updates, and compliance requirements.Assist in the development of new provider-based clinics by ensuring proper regulatory setup for cost-based reimbursement eligibility.
Education/Credentials:
5 years of experience in healthcare reimbursement, finance, or compliance (preferably in a rural hospital setting). Experience with rural hospital funding models, Medicaid programs, and state-specific reimbursement initiatives. Bachelor’s degree in one of the following fields (Required): Accounting, Finance, Healthcare Administration, Business Administration & Economics
Starting Range: To Be Determined
Why Join Us?
We offer a comprehensive benefits package including an Employee Incentive Bonus based on hospital performance and patient satisfaction, a 0-6% annual Retirement Contribution (No Match-403b), 20% employee discounts, Stable Health, Vision, and Dental Insurance premiums, and Paid Time Off starting with 12 hours of PHO, all within a supportive, family-like work culture.
Our competitive salary package is adjusted to align with the candidate's relevant experience and skills.
