Senior Director - Reimbursement

Description

Management/Leadership
Req #: 31341

Summary

Summary:
Works with the Vice President, Reimbursement in departmental planning and budgeting in order to achieve departmental goals and supervision. Responsible for coordinating top level review and approval for submission of Medicare, Medicaid and other Governmental payer cost reports. Develops rate structure and monitors compliance with federal and state regulatory programs. Coordinates the monitoring of implications of all proposed governmental and implemented third party reimbursement changes. Coordinates the preparation, review and approval of local health system Net Patient Service Revenue Budgets. Manages internal system level project requests, coordinating with Decision Support, Contract Management, System Development, Planning, the Central Billing Office and Finance, both local and system level, as necessary. Supervises, mentors and evaluates effectiveness of Director and Managers of reimbursement. Trains staff and educates leadership on higher level reimbursement concepts and their effects on the system. Communicate to local health system and corporate leadership revenue recognition, prior year settlement and reimbursement changes impacting net operating revenue. Ensures all large enrollment projects are equitably distributed amongst reimbursement personnel and completed timely. Coordinates with Vice President to ensure that MaineHealth is achieving the optimal reimbursement under existing regulations and is prepared for proposed regulation changes.

Required Minimum Knowledge, Skills, and Abilities (KSAs)

1. Education: MBA degree or HFMA or CPA certificate is preferred.
2. License/Certifications: N/A
3. Experience: Ten plus years of experience in reimbursement and Medicare/Medicaid cost reporting is required with at least five years of hospital management experience.
4. A high level of interpersonal skills necessary in order to deal with complex situations with a wide variety of internal and external personnel and to make fact based presentations before groups, including regulatory agencies.
5. Knowledge of advanced accounting and reimbursement principles normally acquired through completion of a Bachelor degree program in Accounting, Finance, Business Administration or related field in order to provide the necessary technical direction and management.
6. A high level of problem solving skills necessary in order to develop and implement new procedures and techniques and prepare special and recurring reports and analyses.

If you have questions about this role, please contact Philip R. Ellis at philip.ellis@mainehealth.org