Job Description

KEY RESPONSIBILITIES:

Has the authority to:

  • Carry out the directives of the Division Chief Financial Officer;
  • Evaluate and make recommendations on all reimbursement-related issues and margin analyses;
  • Hire, promote, demote and terminate departmental employees within the guidelines established by the system;
  • Reorganize the Department to meet agreed upon objectives; and
  • Determine the allocation of the Department's annual operating and capital budgets within guidelines established by senior management.

Responsibilities:

  • Provides superior customer service to internal and external clients, customers, and patients as referenced in the Service Excellence Standards;
  • Oversees the preparation and submission of all regulatory reports (e.g., Medicare 2552 Cost Report, D403, UCCR, etc.);
  • Performs direct development and implementation of all NPSR, HSN, and governmental revenue activities including accruals, reserves, and settlements at the hospital levels;
  • Plans, coordinates, and prepares year end audits with public accounting firms and third party auditors as they relate to AR operations;
  • Mediates and resolves conflicts regarding public accounting firms, third party auditors, and investigative parties;
  • Ensures compliance with relevant regulations, standards, and directives from regulatory agencies and third party payers;
  • Collaborates with other leaders with Steward, external agencies, vendors, and partner organizations to achieve improved financial outcomes;
  • Acts as primary contact for all reimbursement issues and advises the financial management team about changes in reimbursement environment and suggest courses of action;
  • Trains all new employees about reimbursement issues and system usage;
  • Evaluates of all medical education reimbursement calculations, which includes scrutinizing all roll forward calculations, affiliation agreements, and residency caps;
  • Reviews all Medicaid and Medicare data to determine Medicare disproportionate share reimbursement;
  • Reviews all third-party settlements to ensure their accuracy and standardize their presentation;
  • Oversees the preparation and review of each hospital's monthly net revenue modeling and helps to evaluate variances to budget;
  • Oversees all audits performed by external firms and/or governmental agencies;
  • Prepares responses to both internal and external questions involving various reimbursement matters to ensure a timely and accurate resolution to all issues;
  • Interacts with division directors and departmental heads to obtain all data necessary to comply with various regulatory requirements;
  • Takes the lead role in reviewing the annual Medicaid RFA to evaluate its impact and coordinate the system's response;
  • Assists with the evaluation and resolution of various compliance matters involving federally funded insurers like Medicare and Medicaid;
  • Oversees the process to identify Medicare+Choice plan discharges so that Medicare senior plan IME billing takes place timely;
  • Participates in the evaluation of all managed care proposals to ensure that all proposals will enable the system to cover costs and can be administered effectively;
  • Completes annual evaluations for all direct reports;
  • Develops the departmental annual operating and capital budgets;
  • Creates new policies and procedures resulting from system and/or operational changes;
  • Makes all decisions governing hiring, promoting, demoting, and terminating staff;
  • Oversees the creation of standardized reports and analyses used to evaluate all RFPs; and
  • Perform other duties as assigned.

Accountable for:

  • Abiding by all relevant policies and procedures;
  • Maintaining the confidentiality and security of all data and information;
  • Maintaining strict adherence to the approved annual operating and capital budget; and
  • Maintaining the integrity and accuracy of all undertaken analyses and evaluations.

REQUIRED KNOWLEDGE & SKILLS:

  • Comprehensive knowledge of all reimbursement-related regulations, hospital reporting requirements, and contractual agreements with third parties.
  • Working knowledge of hospital accounting, patient accounting procedures, and specific rules governing reimbursement for different hospital services.
  • Proven problem-solver with the interpersonal skills to work with people at all levels both inside and outside the system.
  • Able to communicate effectively both verbally and in writing.
  • Well-organized with great attention to detail and the ability to coordinate multiple tasks under tight deadlines.
  • Able to take direction well and have the ability to work independently.

EDUCATION/EXPERIENCE/LICENSURE/TECHNICAL/OTHER:

  1. Education: Bachelor's degree in either business or financial related field. A Master's degree in business, finance, or health care related field is preferred.
  2. Experience: Five to ten years' experience in hospital finance or health care consulting is required. Reimbursement and managed care experience is preferred with keen knowledge about Medicare reimbursement within a teaching environment considered a plus.
  3. Certification/Licensure: N/A
  4. Software/Hardware: Microsoft Excel, Microsoft Access, Microsoft Word, KPMG Cost Reporting/GME software (or similar), and Meditech.
  5. Other: Ability to assume responsibility without direct supervision. Ability to maintain a high level of confidentiality. Membership in a health care trade organization such as HFMA is recommended.

Application Instructions

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