Director of Reimbursement

Job Description

Job Description

Who We Are:We help our neighbors meet immediate needs and face long-term challenges. We steward our resources with transparency and efficiency. Together, we create a community where everyone is able to live with dignity and hope. Impelled by the love and teaching of Jesus Christ, while respecting the dignity and potential of all people, we collaborate to offer life-giving programs, advocate for the voiceless and empower the vulnerable to foster a just society .Catholic Charities Archdiocese of New Orleans (CCANO) has been an open door, a warm welcome, dry ground, a defending voice, and a hand up for generations of Louisiana residents. Our shared stories and strong roots help a diverse community stand tall together. Meeting the needs of the whole person is our continued commitment.What You'll Do:The Director of Reimbursement provides strategic leadership and operational oversight for all revenue cycle, third-party billing, and capitation payment processes specific to the Program of All-Inclusive Care for the Elderly (PACE). This role is responsible for maximizing financial performance, ensuring accurate Medicare and Medicaid capitation rate setting and reconciliation, managing risk adjustment data (RAPS/EDPS), and maintaining strict compliance with federal and state regulatory frameworks. The ideal candidate possesses deep expertise in integrated care financing, capitated payment models, and financial reporting within geriatric or managed care environments.  Key ResponsibilitiesCapitation & Revenue Management:Oversee the end-to-end processing, reconciliation, and auditing of monthly Medicare and Medicaid capitation payments for PACE participants.Monitor and analyze membership/census data, retroactive adjustments, and state-specific Medicaid rate methodologies to ensure optimal revenue realization.Risk Adjustment & Data Submission:Direct the organization's risk adjustment data submission processes (EDPS/RAPS) to ensure complete, accurate, and timely capture of participant diagnostic data.Implement internal audits and clinical documentation improvement (CDI) initiatives to support compliant risk-adjustment scores that accurately reflect the acuity of the PACE population.Financial Reporting & Analysis:Partner with the finance and accounting teams to prepare accurate monthly revenue forecasts, variance analyses, and budgetary reports related to PACE reimbursement.Lead financial modeling for program expansions, new center openings, or changes in state/federal reimbursement policies. Regulatory Compliance & Auditing:Ensure full compliance with Centers for Medicare & Medicaid Services (CMS) and State Administering Agency (SAA) guidelines, regulations, and reporting requirements.Serve as the financial and reimbursement lead during external audits, state desk reviews, and CMS financial/compliance inspections. [Cross-Functional Leadership & Contracting:Collaborate with Clinical, Interdisciplinary Teams (IDT), and Health Information Management (HIM) to align documentation practices with revenue and compliance goals.Assist in negotiating financial terms for external provider network contracts, specialized services, and institutional care, ensuring alignment with PACE capitation constraints.Required Skills/Abilities:Technical Competencies:Expert understanding of CMS regulations, risk adjustment (HCC coding), and Medicaid rate-setting mechanisms.Advanced proficiency in financial modeling, data analytics, and Electronic Health Record (EHR) / billing systems. Soft Skills:Exceptional communication and executive presence, with the ability to translate complex reimbursement data for non-financial clinical and operational leaders.Strong project management skills with a meticulous eye for compliance and detail-oriented problem solving.Perks!Medical, Dental, VisionFSA, HSAIndemnity Plans401k MatchingCompany Paid Life InsuranceCompany Paid STD & LTDWellness Program IncentivesEmployee Referral BonusEAPTeladoc and sooo much more! What You'll Bring:Education:Bachelor 's degree in Finance, Accounting, Healthcare Administration, or a related field.Master's degree (MBA, MHA, or MPA) or CPA/CHFP certification preferred.]Experience:Minimum of 7+ years of progressive financial or revenue cycle management experience within healthcare, with at least 3–5 years focused on managed care, Medicare/Medicaid reimbursement, or capitated health plans.Direct working knowledge of the PACE model or integrated long-term care programs for older adults is strongly preferred. The Catholic Charities Archdiocese of New Orleans is an Equal Opportunity Employer At the CCANO , we are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and employees without regard to race, color, religion or belief, national, social or ethnic origin, sex (including pregnancy), age, disability, sexual orientation, gender identity and/or expression, marital status, veteran service, genetic information, family or parental status, or any other status in accordance with applicable federal, state and local laws. The CCANO expressly prohibits any form of unlawful employee harassment based on any of the characteristics listed here. Improper interference with the ability of CCANO employees to perform their expected job duties is absolutely not tolerated. The CCANO complies with applicable state and local laws governing non-discrimination in employment in every location in which CCANO has facilities. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.