Director, Reimbursement Operations

Department: Technology
Location: Remote
FLSA Status: Exempt

People Leader: Yes
Travel: <5%

Summary

Company Summary

Accuity partners with hospitals and health systems through a technology-enabled, physician-led model that improves clinical documentation integrity, coding accuracy, reimbursement optimization, and quality outcomes.

Job Summary

The Director, Reimbursement Operations provides leadership for reimbursement methodology, onboarding support, and complex reimbursement consulting across Accuity engagements. This role serves as the senior subject matter expert for hospital reimbursement logic, including base rates, DRG classifications, contractual interpretation, and in-scope versus out-of-scope determinations. The Director partners closely with Client Success, Decision Support, and operational leaders to ensure reimbursement methodologies are translated accurately into reporting logic, client communications, and performance interpretation.

Responsibilities

Client Onboarding and Reimbursement Expertise

• Lead reimbursement support for new and prospective clients through onboarding and pre-implementation
• Interpret hospital base rates, reimbursement methodologies, and contractual terms to establish accurate reporting and operational logic
• Clarify reimbursement structures and DRG classifications, including per diem versus DRG-based methodologies and in-scope versus out-of-scope determinations
• Serve as the senior escalation point for complex reimbursement questions from internal teams and clients

Contract and Reporting Alignment

• Translate reimbursement terms and contract provisions into clear operational requirements for reporting, analytics, and client-facing deliverables
• Partner with decision support and reporting teams to ensure reimbursement logic is applied consistently across client reporting packages
• Review new or complex client arrangements to identify risks, assumptions, and implementation requirements
• Establish standards and documentation for reimbursement methodology interpretation and governance

Client Advisory and Issue Resolution

• Participate in client meetings requiring senior-level reimbursement expertise and executive presence
• Explain reimbursement outcomes, methodology changes, and performance drivers in a manner that is clear to executive and operational audiences
• Resolve sensitive or escalated reimbursement issues by balancing contractual requirements, operational realities, and client expectations
• Partner cross-functionally to improve reimbursement accuracy, consistency, and responsiveness

Team Leadership and Operational Excellence

• Lead and develop team members supporting reimbursement operations and reimbursement-related client needs
• Establish quality control standards, review processes, and documentation practices to ensure analytical rigor and consistency
• Drive continuous improvement in reimbursement workflows, knowledge management, and onboarding effectiveness
• Monitor workload, quality, and service expectations to ensure timely and accurate support across engagements

Other Duties as Assigned

• Perform additional responsibilities as needed to support organizational goals and client success

Qualifications

Education and Credentials

• Bachelor’s degree in Business, Finance, Healthcare Administration, or related field required
• Master’s degree in Business, Finance, Healthcare, or related field preferred
• HFMA, CCS, or RHIA certification preferred

Experience

• 10+ years of experience in healthcare reimbursement, revenue cycle, or revenue management required
• 5+ years of people leadership experience required
• Experience interpreting hospital reimbursement methodologies, base rates, DRG logic, and contractual payment terms required
• Experience supporting client onboarding, reimbursement consulting, or complex client-facing issue resolution preferred
• Familiarity with Medicare cost report settlements, DSH adjustments, outlier calculations, or APC/outpatient reimbursement logic preferred

Core Competencies

• Deep expertise in hospital reimbursement methodologies, including MS-DRG and APR-DRG frameworks, base rate construction, Medicaid fee schedules, and commercial managed care contract structures
• Ability to interpret contractual terms and translate them into operational requirements and reporting logic
• Executive presence and confidence in leading complex reimbursement discussions with clients and internal stakeholders
• Strong analytical judgment, problem-solving skills, and attention to detail
• Ability to lead teams, influence cross-functional partners, and improve process discipline in a remote environment

Additional Requirements

1) Physical Requirements: The requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job with or without reasonable accommodations. Unless otherwise indicated, Accuity positions require interaction with people and technology while either sitting or standing. Employees must be able to communicate via phone, email, etc. and sit for extended periods of time, with or without reasonable accommodations. Physical effort and exposure to physical risk are limited to that of an office role / environment.

2) Position and Employment Statement: While this job description is intended to be an accurate reflection of the job requirements, management reserves the right to modify, add or remove duties from a job and to assign other duties as necessary and at any time. All positions at Accuity Delivery Systems, LLC, are at-will employment, and a position description is not a guarantee of a job or of job responsibilities.

While this job description is intended to be an accurate reflection of the job requirements, management reserves the right to modify, add or remove duties from a job and to assign other duties as necessary and at any time. All positions at Accuity are at-will employment, and a position description is not a guarantee of a job or of job responsibilities.