The Director of Reimbursement is responsible for enterprise oversight of acute care reimbursement compliance, regulatory reporting, and payment policy execution for a $1B+ acute-care health system. This role leads financial reimbursement activities regulated by the Maryland Health Services Cost Review Commission (HSCRC) and supports acute care reimbursement and regulatory compliance across governmental and commercial payers.
The Director implements established reimbursement strategies and manages reimbursement services through accurate financial reporting, analytics, and audit readiness to demonstrate compliance and identify opportunities for revenue optimization within Maryland’s all-payer model.
In Maryland’s unique rate-setting environment, the Director serves as one of the health system’s subject matter experts for HSCRC & AHEAD compliance, financial filings, and related regulatory requirements, including global budget methodologies and price transparency standards.
The Director partners closely with Finance, Strategic Analytics, Revenue Cycle, Case Management, and external auditors to optimize reimbursement, minimize regulatory risk, and ensure timely and accurate reporting across federal and state payment programs.
As a Director of Reimbursement you will:
Medicare Cost Reporting & Federal Reimbursement Oversight
• Direct the preparation, completion, and filing of the annual Medicare cost report for all acute-care hospitals within the system.
• Ensure compliance with CMS reimbursement rules, including cost allocation methodologies, provider-based regulations, and payment adjustments.
• Manage Medicare reimbursement audits, desk reviews, appeals, and related settlement activity.
• Oversee completion of the annual Medicare Wage Index and Occupational Mix Surveys, ensuring accuracy and optimizing reimbursement positioning.
• Lead enterprise Medicare & Medicaid reimbursement strategy.
AHEAD and HSCRC Rate Compliance & Maryland Regulatory Reporting
• Provide leadership and oversight for HSCRC reimbursement policy execution, including compliance with Maryland all-payer rate-setting requirements and new AHEAD requirements.
• Ensure accurate preparation and submission of required HSCRC filings, including:
• Annual Hospital Filing
• Monthly financial reporting and volume monitoring
• Uncompensated Care (UCC) / charity care reporting
• Global Budget Revenue (GBR) compliance schedules
• Price variance and revenue integrity reconciliations
• Lead monthly earned revenue computation for financial reporting and operational implications, including charge master rate adjustments as needed to maintain compliance.
• Monitor HSCRC and AHEAD policy updates and translate methodology changes into financial action plans.
• Coordinate with Revenue Cycle and patient revenue management teams to support cash collection, revenue optimization, and compliant growth.
• Serve as a primary liaison with HSCRC staff on reimbursement compliance, reviews, and regulatory inquiries.
• Identify reimbursement opportunities and implement strategies aligned with system finance and strategic leadership. Collaborate with Strategic Analytics on reimbursement strategy and reimbursement policy performance
• Supervise preparation and support of reimbursement-related audits and statistical reports for HSCRC, Medicare, Medicaid, and other third-party payers, minimizing reliance on external consultants.
Charge Master Integrity & Revenue Compliance
• Oversee the integrity of the hospital charge master, ensuring alignment with CPT/HCPCS requirements, CMS billing regulations, and HSCRC pricing compliance.
• Lead routine charge master audits, governance processes, and pricing review structures.
• Partner with coding, compliance, and revenue integrity teams to reduce billing risk and support accurate reimbursement.
• Collaborate with Finance and Revenue Cycle on optimization of charge capture, documentation, CMI and related policies.
Reimbursement Analytics & Strategic Financial Support
• Analyze reimbursement trends across Medicare, Medicaid, commercial payers, and Maryland all-payer structures.
• Support financial modeling for reimbursement impacts related to volume shifts, service line growth, and regulatory policy updates.
• Prepare accounts receivable reserve and reimbursement analytics to support financial statement close.
• Provide reimbursement forecasting support in collaboration with Budgeting and Strategic Analytics.
• Support revenue budget development, including NPSR projections and patient service volume forecasting.
Audit Management & External Relationship Oversight
• Manage reimbursement-related interactions with external auditors, consultants, CMS contractors, and HSCRC reviewers.
• Coordinate responses to audit activity and ensure documentation, controls, and defensibility are maintained.
Leadership & Enterprise Collaboration
• Lead, mentor, and develop a high-performing reimbursement team.
• Partner with stakeholders across Finance, Revenue Cycle, Compliance, Case Management, Strategic Analytics, and operational leadership.
• Provide executive-level reporting on reimbursement performance, risks, and opportunities, translating complex reimbursement issues for senior leaders.
• Build strong internal and external relationships with regulatory peers and statewide partners.
Qualifications include:
• Bachelor’s degree in Finance, Accounting, Health Administration, or related field (Master’s preferred).
• 7–10 years of progressive reimbursement experience in an acute-care hospital or health system environment.
• Demonstrated expertise in Medicare cost reporting, wage index, charge master oversight, and reimbursement compliance.
• Strong understanding of governmental hospital rate regulation; Maryland HSCRC methodology experience preferred.
• Deep technical reimbursement and regulatory expertise
• Strong analytical and modeling skills (advanced Excel)
• Proven audit defense and compliance leadership
• Effective communicator with executive presence
• Ability to operate strategically in a complex regulated environment
Work Schedule:
Monday through Friday 8am-5pm
Pay Range:
$140,635.76 - $210,953.64If the salary range is listed as $0 or if the position is Per Diem (with a fixed rate), salary discussions will take place during the screening process.
Under the Fair Labor Standards Act (FLSA), this position is classified as:
United States of America (Exempt)At Adventist HealthCare our job is to care for you.
We do this by offering:
Work life balance through nonrotating shifts
Recognition and rewards for professional expertise
Free Employee parking
Medical, Prescription, Dental, and Vision coverage for employees and their eligible dependents effective on your date of hire
Employer-paid Short & Long-Term Disability, Basic Life Insurance and AD&D, (short-term disability buy-up available)
Paid Time Off
Employer retirement contribution and match after 1-year of eligible employment with a 3-year vesting period
Voluntary benefits include flexible spending accounts, legal plans, and life, pet, auto, home, long term care, and critical illness & accident insurance
Subsidized childcare at participating childcare centers
Tuition Reimbursement
Employee Assistance Program (EAP) support
As a faith-based organization, with over a century of caring for the communities in the Maryland area, Adventist HealthCare has earned a reputation for high-quality, compassionate care. Adventist HealthCare was the first and is the largest healthcare provider in Montgomery County.
If you want to make a difference in someone’s life every day, consider a position with a team of professionals who are doing just that, making a difference.
Join the Adventist HealthCare team today, apply now to be considered!
COVID-19 Vaccination
Adventist HealthCare strongly recommends all applicants to be fully vaccinated for COVID-19 before commencing employment. Applicants may be required to furnish proof of vaccination.
Tobacco and Drug Statement
Tobacco use is a well-recognized preventable cause of death in the United States and an important public health issue. In order to promote and maintain a healthy work environment, Adventist HealthCare will not hire applicants for employment who either state that they are nicotine users or who test positive for nicotine and drug use.
While some jurisdictions, including Maryland, permit the use of marijuana for medical purposes, marijuana continues to be classified as an illegal drug under the federal Controlled Substances Act. As a result, medical marijuana use will not be accepted as a valid explanation for a positive drug test result.
Adventist HealthCare will withdraw offers of employment to applicants who test positive for Cotinine (nicotine) and marijuana. Those testing positive are given the opportunity to re-apply in 90 days, if they can truthfully attest that they have not used any nicotine products in the past ninety (90) days and successfully pass follow-up testing. ("Nicotine products" include, but are not limited to: cigarettes, cigars, pipes, chewing tobacco, e-cigarettes, vaping products, hookah, and nicotine replacement products (e.g., nicotine gum, nicotine patches, nicotine lozenges, etc.).
Equal Employment Opportunity
Adventist HealthCare is an Equal Opportunity/Affirmative Action Employer. We are committed to attracting, engaging, and developing the best people to cultivate our mission-centric culture. Our goal is to have a welcoming, equitable, and safe place to work and grow for all employees, no matter their background. AHC does not discriminate in employment opportunities or practices on the basis of race, ethnicity, color, religion, sex, national origin, age, disability, sexual orientation, gender identity, pregnancy and related medical conditions, protected veteran status, or any other characteristic protected by law.
Adventist HealthCare will make reasonable accommodations for applicants with disabilities, in accordance with applicable law. Adventist HealthCare is a religious organization as defined under applicable law; however, it will endeavor to provide reasonable accommodations for applicants’ religious beliefs.
Applicants who wish to request accommodations for disabilities or religious belief should contact the Support Center HR Office.