State of Tennessee · 3 hours ago
DIRECTOR OF PROVIDER REIMBURSEMENT - 74804
Davidson County, TN
Full-time
Hybrid
Lead/Staff, Director/Executive
5+ years expThe State of Tennessee is dedicated to providing health insurance coverage through its managed care Medicaid program, TennCare. The Director of Provider Reimbursement oversees provider payment methodologies and ensures timely and accurate reimbursement to healthcare providers, while collaborating with internal and external stakeholders to maintain financial integrity.
AgricultureChildrenEducationGovernmentHealth Care
Responsibilities
Oversee implementation of all hospital supplemental payment programs, ensuring timely execution and compliance with state and federal requirements
Oversee implementation and completion of hospital supplemental payment reconciliations, including the DSH audit, Certified Public Expenditure (CPE) reconciliation, and other required reconciliations
Oversee implementation and administration of the Hospital Assessment Program, ensuring accurate collections and distributions
Oversee implementation of the Hospital Directed Payment Program, coordinating across internal and external stakeholders to ensure alignment with CMS-approved methodologies
Manage and maintain the Prospective Payment System (PPS) for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs), including updates to rates and policy improvements
Identify and implement process improvements to enhance efficiency, accuracy, and audit readiness for payment and reconciliation activities
Conduct and oversee provider rate analyses and related financial modeling to inform policy and operational decisions
Manage stakeholder relationships with key external partners, including provider associations, healthcare providers, and federal government agencies
Contribute to legislative feedback and reporting processes, ensuring timely and accurate input into policymaking and oversight activities
Provide subject-matter expertise on provider payment topics, collaborating with leadership to ensure fiscal sustainability and compliance
Perform other related duties as assigned by the Chief Financial Officer
Qualification
Required
Graduation from an accredited college or university with a bachelor's degree in business administration, accounting, finance, economics, health policy, or related acceptable field
Experience equivalent to five or more years of full-time professional fiscal services and/or auditing work including, at least, two years of experience in the supervision of fiscal and/or auditing staff
Strong understanding of Medicaid and healthcare reimbursement methodologies
Ability to manage complex financial programs and multiple concurrent deadlines
Excellent analytical and quantitative skills, including data-driven decision-making
Strong leadership and team management capabilities
Effective communication skills for both technical and non-technical audiences
Commitment to accuracy, transparency, and compliance
Preferred
Demonstrated experience managing complex reimbursement or supplemental payment programs
Master's degree in Business Administration, Accounting, Public Policy, or related field
Experience with Medicaid hospital supplemental payment programs or CMS rate-setting methodologies
Familiarity with cost reporting, actuarial analysis, and federal audit requirements
Company
State of Tennessee
State government is the largest employer in Tennessee, with approximately 43,500 employees in the three branches of government.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Hugh Hale
Chief Information Officer, TennCare
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