AVP, Government Reimbursement

Thank you for considering a career at Ensemble! Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful.

This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference!

• Customer Obsession:
  Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations.
• Embracing New Ideas:
  Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation.
• Striving for Excellence:
  Execute at a high level by demonstrating our “Best in KLAS” Ensemble Difference Principles and consistently delivering outstanding results.

The Opportunity:

Assistant Vice President, Government Reimbursement By embodying our core purpose of customer obsession, new ideas, and driving innovation, and delivering excellence, you will help ensure that every touchpoint is meaningful and contributes to our mission of redefining the possible in healthcare. This role will serve in a consultancy capacity, advising our clients, large health systems, in managing and optimizing healthcare reimbursement processes, focusing on Medicare, Medicaid, Disproportionate Share Hospital (DSH) programs, Medicaid Directed Payment programs, and 340B drug pricing and reimbursement.

Additionally, this position provides key support in the preparation and analysis of Medicare cost reports, ensuring compliance with federal regulations and maximizing financial performance for healthcare providers.

Customer Obsession:
Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations. Embracing New Ideas:
Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation. Striving for Excellence:
Execute at a high level by demonstrating our “Best in KLAS” Ensemble Difference Principles and consistently delivering outstanding results.

• Assist in gathering and analyzing data for the preparation of Medicare cost reports, ensuring accurate reflection of hospital costs for reimbursement optimization.
• Provide expert advice on reimbursement strategies for governmental lines of business, including Medicaid and Tricare.
• Support 340B program compliance, eligibility, and ensure correct billing processes.
• Analyze hospital eligibility for DSH payments, assess financial impact, and ensure complete and accurate capture of Medicaid days and other considerations.
• Monitor Medicaid Directed Payment programs, optimizing revenue opportunities for participating providers.
• Serve as a trusted advisor to clients, offering strategic insights and recommendations on reimbursement-related matters.
• Maintain expert-level knowledge of state and federal healthcare reimbursement policies, ensuring strict compliance with CMS guidelines, Medicaid Managed Care rules, and HRSA 340B program regulations.
• Assist healthcare providers in navigating reimbursement complexities, including audits, appeals, and compliance inquiries.
• Analyze financial data to identify trends and areas for improvement in the reimbursement process.
• Build and maintain strong relationships with payers, government agencies, and other stakeholders.
• Provide guidance and…