DIRECTOR OF PROVIDER REIMBURSEMENT - 73366

Executive Service

The Division of TennCare is dedicated to providing our employees with a hybrid work environment. All TennCare positions have a combination of work from home and work in the office, which varies by position, department, and business need. You may review the specific expectations with our hiring team.

Background Check:

This position requires a criminal background check. Therefore, you may be required to provide information about your criminal history in order to be considered for this position

Who we are and what we do:

TennCare is Tennessee's managed care Medicaid program that provides health insurance coverage to certain groups of low-income individuals such as pregnant women, children, caretaker relatives of young children, older adults, and adults with physical disabilities. TennCare provides coverage for approximately 1.7 million Tennesseans and operates with an annual budget of approximately $14 billion. It is run by the Division of TennCare with oversight and some funding from the Centers for Medicare and Medicaid Services (CMS). TennCare's mission is to improve the lives of Tennesseans by providing high-quality cost-effective care. To fulfill that purpose, we equip each employee for active participation and empower teams to communicate and worked collaboratively to improve organizational processes in order to make a difference in the lives our members. Because of the positive impact TennCare has on the lives of the most vulnerable Tennesseans, TennCare employees report that their work provides them with a sense of meaning, purpose, and accomplishment. TennCare leadership understands that employees are our most valuable resource and ensures professional and leadership development are a priority for the agency.

Job Overview:

The Director of Provider Reimbursement oversees all aspects of provider payment methodologies, ensuring timely, accurate, and compliant reimbursement to healthcare providers. This position leads the design, implementation, and improvement of payment systems and supplemental programs that support hospital and non-hospital providers. The Director works closely with internal finance, policy, and actuarial teams, as well as external partners, to ensure financial integrity and transparency across all provider reimbursement programs.

Key Responsibilities:

1. Oversee implementation of all hospital supplemental payment programs, ensuring timely execution and compliance with state and federal requirements.
2. Oversee implementation and completion of hospital supplemental payment reconciliations, including the DSH audit, Certified Public Expenditure (CPE) reconciliation, and other required reconciliations.
3. Oversee implementation and administration of the Hospital Assessment Program, ensuring accurate collections and distributions.
4. Oversee implementation of the Hospital Directed Payment Program, coordinating across internal and external stakeholders to ensure alignment with CMS-approved methodologies.
5. 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.
6. Identify and implement process improvements to enhance efficiency, accuracy, and audit readiness for payment and reconciliation activities.
7. Conduct and oversee provider rate analyses and related financial modeling to inform policy and operational decisions.
8. Manage stakeholder relationships with key external partners, including provider associations, healthcare providers, and federal government agencies.
9. Contribute to legislative feedback and reporting processes, ensuring timely and accurate input into policymaking and oversight activities.
10. Provide subject-matter expertise on provider payment topics, collaborating with leadership to ensure fiscal sustainability and compliance.
11. Perform other related duties as assigned by the Chief Financial Officer.

REQUIRED COMPETENCIES:

• 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.

Minimum Qualifications:

Preferred Education and Experience: Graduation from an accredited college or university with a bachelor's degree in business administration, accounting or related acceptable field and 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.

Necessary Special Qualifications: Determined by the appointing authority. Examination Method: Determined by the appointing authority.

Pursuant to the State of Tennessee's Workplace Discrimination and Harassment policy, the State is firmly committed to the principle of fair and equal employment opportunities for its citizens and strives to protect the rights and opportunities of all people to seek, obtain, and hold employment without being subjected to illegal discrimination and harassment in the workplace. It is the State's policy to provide an environment free of discrimination and harassment of an individual because of that person's race, color, national origin, age (40 and over), sex, pregnancy, religion, creed, disability, veteran's status or any other category protected by state and/or federal civil rights laws.