Director – Reimbursement and Analytics

Title: Director of Reimbursement & Analytics

Department: Reimbursement

Reports to: VP of Revenue Cycle

FLSA Status: Exempt

Direct Reports:

Position Overview:

The Director of Reimbursement and Analytics provides strategic leadership in reimbursement strategy, regulatory reporting, and advanced financial analytics to support Luminis Health’s operational and growth initiatives. This role serves as a key resource in developing and integrating financial planning tools, performance metrics, and reimbursement insights that improve operational efficiency and fiscal performance.

Key Responsibilities:

1. Strategic Revenue Analytics

· Oversee the development of analytical tools and dashboards to monitor reimbursement trends, payer performance, and revenue optimization opportunities.

· Leverage data to guide revenue strategy and optimization efforts, ensuring alignment with LH’s financial performance goals and improvement initiatives.

2. Revenue Budget Development and Oversight

· Lead the creation and monitoring of the annual revenue budget, ensuring alignment with organizational financial goals

· Provide actionable insights on budget variances based on ongoing analytics and performance metrics

3. Denials Analytics and Management

· Lead analytics on claims denials, identifying root causes and trends, and providing actionable solutions designed to address and resolve payor denials

· Oversee a team of analysts responsible for driving projects and initiatives that recover revenue identified as strategic priorities across the organization

· Lead the Denial Prevention Task Force, working in collaboration with hospital leadership, physicians, and Utilization Review (UR) teams to track progress, identify challenges, and implement initiatives to reduce denials and improve reimbursement.

· Collaborate with legal and billing to resolve payer issues using data driven cases.

4. Clinical Quality Optimization

· Collaborate with Quality leadership to manage financial incentives tied to HSCRC quality programs (QBR, RRIP, MHAC), maximizing reimbursement.

· Align quality initiatives with revenue optimization in partnership with clinical leadership.

5. Reimbursement Activities

· Oversee all reimbursement activities including HSCRC and Medicare reporting, GBR/unit rate compliance, and related internal reporting.

· Actively participate in HSCRC and MHA workgroups to stay abreast of regulatory changes impacting reimbursement and the hospital industry, communicating changes/impacts with executive leadership.

· Oversee analytics related to internal and external requests for information and special projects regarding regulated revenue and strategic initiatives

Educational/Experience Requirements:

• Bachelor’s degree in finance, Accounting, Statistics, Healthcare or a related field from an accredited college or university.
• 7-10+ years of progressively responsible related experience in healthcare reimbursement regulations, cost accounting, and operations including 3-5 years of management experience.
• Requires extensive knowledge of HSCRC and Medicare regulations, health care planning, budgeting, pricing, and hospital organization.
• Requires a professional level of knowledge of financial and accounting principles.
• Ability to manage multiple projects and prioritize work under minimal supervision.
• Strong knowledge of computer software programs.

Required License / Certifications:

• None

Working Conditions / Physical Demands:

This position is classified as Light Work — exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently. The physical demands and work environment described are representative of those typically encountered while performing the essential functions of this role. Reasonable accommodations may be made in accordance with the Americans with Disabilities Act (ADA).

Note: This job description outlines the general nature and level of work performed by individuals assigned to this position. It is not intended to be an exhaustive list of duties, responsibilities, or qualifications associated with the role. Additional duties may be assigned as necessary.