Reimbursement Director

Intermountain Health • Dayton, OH

3d • $67 - $104

About The Position

This is a system-wide role within Intermountain's Corporate offices. The position helps manage the government reimbursement personnel for the corporation, and it reports to the Reimbursement Senior Director. This position assists in the direction of the following areas for government payers for the Corporation: interim and final payment processes, general ledger accounting, rolling forecasts, and analysis. The position provides central direction and education for the technical and operational aspects of the government reimbursement area and helps ensure the technical accuracy and proper functioning of all government payer systems and operational processes. The position monitors new payment-related legislation and regulations and advises Central Office and Hospital management of its implications for all government reimbursement areas including contractual allowance calculations, feasibility studies, cost reports, and financial forecasts. This position interacts with the internal and external auditors and assists in lobbying efforts to ensure that Intermountain's interests are represented. The incumbent interacts with various government agencies, including national, regional and state level Medicare agencies and Medicare administrative contractors, national and state (Idaho and Utah) Medicaid agencies, TRICARE agencies, and state hospital associations.

Requirements

• Bachelor’s degree in accounting, Finance or other business related field with thirteen years’ experience ten of which must be in Reimbursement/Governmental reporting. A degree must be obtained from an accredited institution. Education is verified.
• Master’s degree in accounting, Finance, or other business-related field with eleven years’ experience ten of which must be in Reimbursement/Governmental reporting. Education must be obtained from an accredited institution. Degree will be verified.
• Demonstrated ability to work effectively in a team environment and work collaboratively with others.
• Self-motivated with the demonstrated ability to work with limited direct supervision.
• Demonstrated flexible and adaptable to change.
• Demonstrated detailed oriented with strong analytical skills.
• Demonstrated excellent communication skills (both written and oral) with the ability to communicate with all levels of the organization.
• Direct supervisory experience with demonstrated leadership abilities.
• Experience in a role requiring a proficient knowledge of hospital accounting systems, hospital operations, and financial projections.
• Demonstrated flexibility and adaptable to change.
• Demonstrated excellent communication skills (both written and oral) with the ability to communicate with all levels of the organization.
• Computer skills including spreadsheets, databases, word processing, and Internet.
• Reconciliation
• Accounting
• Accounts Payable/Receivable Process
• Governmental Reporting, ie, Medicare and Medicaid cost reports, Medicaid DSH surveys, Tricare Capital Reports, etc.
• General Ledger
• Financial Statements
• Analytical Thinking
• Reimbursement
• Government Regulations
• Departmental Supervision and Leadership

Nice To Haves

• MBA
• Masters of Accountancy
• CPA license.

Responsibilities

• Financial Accounting: Identifies material regulatory or statutory changes to include in Medicare and Medicaid contractual allowance calculations to have technically acceptable and reasonably conservative reimbursement methodologies. Helps develop and review the calculation templates or other reporting output to determine the impacts of the regulatory or statutory changes are appropriately applied. Reviews government payment calculations, government payer general ledger reconciliations, claims monitoring logs, and systems managed by the Reimbursement Director’s direct reports as well as those for assigned Intermountain facilities. Communicates with Revenue Cycle, Accounting, Information Systems, Internal Audit, and the External Auditors to ensure that all operational systems are appropriate and functioning.
• Rolling Forecasts and Financial Modeling: Helps determine financial forecast assumptions for the rolling forecasts and the 5- year plan for Medicare and Medicaid reimbursement. Reviews the appropriateness of the assumption calculations in the software for rolling forecasts and 5-year plans. Provides prospectus assumption information for long-term debt (i.e., bond) financing, interprets current law, and anticipates future trends and legislation.
• Government Reporting Requirements: Responsible for the central development and review of spreadsheet applications and software and reimbursement methodologies for Medicare and Medicaid cost report work papers, surveys, and other government reporting. Responsible for Central Office cost report preparation and/or review and for the review of assigned facility cost reports. Negotiates with government agencies on behalf of the hospitals in resolving interim and final payment disputes. Works with internal and external legal counsel and Compliance to resolve disputes in the governmental appeal and legal processes.
• Knowledge of Government Payer Regulations and Laws: Monitors new payment-related legislation and regulations for the government reimbursement area and directs the preparation of analyses and the provision of recommendations to Central Office and Hospital management of service changes and/or rate adjustment requests which would enhance reimbursement and/or make operations more efficient.
• Personnel Management: Supervises, evaluates, and educates personnel under his/her direction. Ensures that workloads are appropriately managed throughout the year so that all required work is completed accurately and timely during peak work periods.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Number of Employees: 5,001-10,000 employees