DIR NET REVENUE & REIMB

Director of Net Revenue & Reimbursement, Accounting and Finance

Full Time, 80 Hours Per Pay Period, Day Shift

Covenant Health Overview:

Covenant Health is the region’s top-performing healthcare network with 10 hospitals, outpatient and specialty services, and Covenant Medical Group, our area’s fastest-growing physician practice division. Headquartered in Knoxville, Covenant Health is a community-owned integrated healthcare delivery system and the area’s largest employer. Our more than 11,000 employees, volunteers, and 1,500 affiliated physicians are dedicated to improving the quality of life for the more than two million patients and families we serve every year. Covenant Health is the only healthcare system in East Tennessee to be named a Forbes “Best Employer” seven times.

Position Summary:

The Director of Net Revenue & Reimbursement is responsible for leading Covenant Health’s reimbursement strategy across all payors, including Medicare, Medicaid/TennCare, and commercial insurers. This role ensures accurate regulatory filings, strategic alignment with managed care contracts, and effective collaboration with the Billing Office to optimize revenue cycle operations and financial performance.

Recruiter:

Suzie Mcguinn

Responsibilities

Medicare & Medicaid Reimbursement Oversight

Lead all phases of Medicare cost reporting: preparation, review, filing, audit response, amendments, and appeals.

Oversee Medicaid/TennCare filings and ensure compliance with state-specific requirements.

Manage annual JAR filings and other external surveys.

Collaborate with internal teams to ensure accurate data submission for TennCare supplemental fund allocation.

Regulatory Compliance & Reporting

Monitor and interpret CMS and TennCare regulations, ensuring timely updates to internal processes.

Develop tools and systems to capture and report Medicare, Medicaid/TennCare and other governmental data.

Coordinate with external consultants on DSH, SSI, S-10, Wage Index, and 340B-related matters.

Revenue Cycle & AR Management

Oversee AR template processes and ensure accurate contractual reserve calculations.

Collaborate with Financial Analytics, Business Office, and IT to resolve data integrity issues and improve reporting systems.

Support independent audits and ensure accurate third-party settlement calculations

Managed Care Collaboration

Act as an intermediary between the reimbursement and managed care teams to align financial strategies with payer contracts.

Provide insights into payment trends and rate changes and ensure accurate application of CMS published rates.

Payor Strategy & Billing Office Collaboration

Maintain comprehensive knowledge of all payor types including Medicare, Medicaid/TennCare, commercial insurers, and managed care organizations.

Analyze payor mix trends and reimbursement methodologies to inform strategic financial planning.

Collaborate closely with the Billing Office team to ensure accurate charge capture, billing practices, and timely resolution of reimbursement issues.

Leadership & Strategic Planning

Supervise and mentor Reimbursement and AR template analysts, ensuring access to current regulatory information and tools.

Develop and implement departmental work plans and performance evaluations.

Communicate reimbursement impacts and legislative changes to executive leadership.

Follows policies, procedures, and safety standards. Completes required education assignments annually. Works toward achieving goals and objectives and participates in quality improvement initiatives as requested.

Performs other duties as assigned.

Qualifications

Minimum Education:

Bachelor’s degree in Accounting, Finance, Healthcare Administration, or related field.

Minimum Experience:

Minimum 7 years of experience in hospital reimbursement or revenue cycle management, with at least 3 years in a leadership role.

Licensure Requirement:

None.

Full-Time