ASSOCIATE VICE PRESIDENT, REIMBURSEMENT

Froedtert • Menomonee Falls, WI

1d • Hybrid

About The Position

The Associate Vice President, Reimbursement provides strategic and operational leadership for all reimbursement-related functions and processes. This role acts as a trusted advisor to executive leadership on reimbursement matters. This system level role leads the reimbursement program and modeling, cost reporting, regulatory compliance, and partners with government relations to support advocacy efforts, among many other imperatives outlined below. The Associate Vice President, Reimbursement partners across the system with finance, revenue cycle, government relations, managed care, office of general counsel, and operational leaders to optimize reimbursement, ensure regulatory compliance, and support the system’s long-term financial sustainability. Other duties as assigned.

Requirements

• A minimum of 7 years of experience in Medicare, Medicaid, managed care and other reimbursement methodologies is required.
• Bachelor’s Degree in Business Administration with emphasis in Accounting or Finance is required.

Nice To Haves

• MBA preferred.
• CPA preferred.

Responsibilities

• Lead modernization of the reimbursement program, emphasizing automation and process improvement initiatives to reduce manual work and enhance analytics. Continuous improvement of the internal control environment is critical to ensure high quality service and products.
• Ensure timely and accurate preparation of annual Medicare/Medicaid cost reports for all affiliate hospitals along with parent Home Office cost report. Coordinate the annual Medicare audit and any special audits along with related correspondence. Proactively recommends appropriate operational changes to optimize reimbursement in compliance with regulations.
• Lead preparation and analysis of contractual allowances, bad debt and third party liabilities on a monthly basis. Ensure accounts receivable and third party liabilities are valued and reserved appropriately on the balance sheet. Delivers clear, concise variance explanations throughout the year. Has primary responsibility of reviewing the contractual allowances, bad debt allowances and third party liabilities reserves with the external auditors for the system.
• Builds strong relationships and provides support to: a.) Sr. VP of Finance and CFO of the system as we liaison with the Wisconsin Hospital Association (WHA) for third party reimbursement matters. b.) system Governmental Relations Office. This may include representing the system in matters that impact both hospitals at the county level, state level and national level. c.) system Office of General Counsel on matters related to Medicare and Medicaid regulation and specifically on compliance-related matters.
• Responsible for reimbursement modeling and analyses to ensure that reimbursement from all payers has been optimized and that current payment methodologies are optimal within each hospital.
• Coordinate and record all financial activity of the hospitals in support of various Medical College of Wisconsin (MCW) departments. Analyze the cost to FT of supporting medical education and the financial impact on the operation of the hospitals. Monitor medical education costs and reimbursements. This includes providing support to FT’s Medical Officers on the annual Hospital budgets.
• Coordinate third party reimbursement activities for FT: a.) Coordinate activities that involve interaction with CMS or its intermediaries. b.) Recommend appropriate operational changes to ensure compliance with federal and state regulations. c.) Recommend appropriate operational changes to optimize reimbursement in compliance with regulations. d.) Perform analyses and audits of accounts receivable and third party liabilities to ensure that they are valued and reserved appropriately. e.) Research reimbursement matters for executive management. f.) Interpret promulgations from governmental bodies for executive management.
• Provides input on all reimbursement matters and assists in the preparation of the annual operating and capital budgets for FT. Provides input on all reimbursement matters and assists in the preparation of the annual update of the five-year operating and capital plan.
• Responsible for maintaining and supporting the decision support system reimbursement module. This includes the loading of and reviewing of governmental and nongovernmental contract payer information.
• To be the main contact in Finance as it related to disclosing financial data in the community benefit reporting. In addition, play an active role in the Milwaukee Health Partnership in financial data reporting and maintaining consistency across systems.
• Other duties as assigned.

Benefits

• Paid time off
• Growth opportunity- Career Pathways & Career Tuition Assistance, CEU opportunities
• Academic Partnership with the Medical College of Wisconsin
• Referral bonuses
• Retirement plan - 403b
• Medical, Dental, Vision, Life Insurance, Short & Long Term Disability, Free Workplace Clinics
• Employee Assistance Programs, Adoption Assistance, Healthy Contributions, Care@Work, Moving Assistance, Discounts on gym memberships, travel and other work life benefits available

What This Job Offers

• Job Type: Full-time
• Career Level: Executive