Pennsylvania Licensed Reimbursement Director

Job Summary

A company is looking for a Director of Provider Reimbursement Strategy to drive sustainable reimbursement models and financial performance across a provider network.

Key Responsibilities

• Establish and lead reimbursement strategies and payment methodologies across multiple provider types and markets
• Oversee financial modeling, benchmarking, and payment analysis supporting provider negotiations and network growth
• Ensure claims payment accuracy through strong analytical processes, contract alignment, and reimbursement governance

Qualifications

• Extensive experience in provider reimbursement, payment methodology design, and healthcare financial analysis
• Strong working knowledge of Pennsylvania Medicaid, CMS Medicare, and industry standard payment models
• Proven ability to translate complex data into actionable insights for contracting and executive decision making
• Demonstrated leadership experience building, mentoring, and retaining high caliber analytical teams
• Advanced analytical, communication, and collaboration skills within matrixed healthcare environments