Director of Reimbursement And Regulatory Compliance

Director of Reimbursement & Regulatory Compliance

Location: Clinton, MO

Schedule: Full-time | Monday Friday, 8:00 AM 5:00 PM | No weekends

Position Overview:

We are seeking a Director of Reimbursement & Regulatory Compliance to oversee all aspects of Medicare and Medicaid cost reporting, Disproportionate Share Hospital (DSH) funding, and regulatory compliance for a Sole Community Rural Hospital (SCH) and its provider-based clinics. This role is critical in ensuring compliance with federal and state regulations while developing financial strategies to optimize hospital and clinic reimbursement.

Key Responsibilities:

Reimbursement & Financial Reporting

• Oversee the preparation, submission, and analysis of Medicare and Medicaid cost reports for the hospital and provider-based clinics.
• Ensure the hospital maintains Sole Community Hospital (SCH) designation benefits and meets all eligibility requirements.
• Manage DSH and Uncompensated Care reporting, ensuring accurate documentation to maximize financial recovery.
• Monitor and optimize rural health clinics (RHC) and provider-based billing for compliance and maximum reimbursement.
• Lead financial modeling and forecasting to assess reimbursement impacts.

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 primary 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 and enhance compliance.
• Collaborate with external auditors and consultants to support reimbursement initiatives.

Strategic & Operational Collaboration

• Partner with hospital leadership, CFO, revenue cycle, and compliance teams to develop financial sustainability strategies.
• Educate internal teams on reimbursement trends, rural hospital policies, and compliance requirements.
• Assist in the development of new provider-based clinics, ensuring proper regulatory setup for cost-based reimbursement eligibility.

Qualifications:

• 5+ years of experience in healthcare reimbursement, finance, or compliance (preferably in a rural hospital setting).
• Bachelors degree required in Accounting, Finance, Healthcare Administration, Business Administration, or Economics.
• Experience with rural hospital funding models, Medicaid programs, and state-specific reimbursement initiatives.
• Strong knowledge of Medicare and Medicaid regulations, cost reporting, and financial forecasting.

Compensation & Benefits:

• Base Salary: $98,200 (with experience-based increases up to $117,840).
• Employee Incentive Bonus based on hospital performance and patient satisfaction.
• Retirement Contribution: 0-6% annual employer contribution (403(b), no match).
• Health, Vision, and Dental Insurance with stable premiums.
• Paid Time Off (PTO): Starting with 12 hours of PTO per month.
• Employee Discounts: 20% discounts on hospital services.
• Supportive, family-like work culture with opportunities for career growth and development.

Why Join Our Client?

This is an exciting opportunity to make a direct impact on the financial health and sustainability of a rural healthcare system. If you have strong expertise in healthcare reimbursement and regulatory compliance, and you're looking for a leadership role with stability, growth, and meaningful work, we encourage you to apply!