Medicaid Reimbursement DirectorAltamonte Springs, FL

Medicaid Reimbursement Director

Hospitals, medical centers and facilities need more than physicians, nurses and specialists delivering care to our patients. A truly successful health care organization needs a thoughtful, dedicated, steady and experienced team working behind the scenes to make sure communities around the country receive the health care they need.

If you've also been interested in working in the health care field but aren't a health care provider, a corporate career at AdventHealth may just be the perfect fit. We're a faith-based health care organization headquartered in Altamonte Springs, Florida. As a national leader in quality, safety and patient satisfaction, our 92,000 team members maintain a long tradition of whole-person health by caring for the physical, emotional and spiritual needs of every patient.

Start your journey with a health care career at AdventHealth Corporate.

Every day, our fellow team members show up to work, unified by one shared mission : Extending the Healing Ministry of Jesus Christ. As a faith-based health care organization, our story is one of hope as we strive to heal and restore the body, mind and spirit. Though our facilities are spread across the country, this unwavering belief binds us together. Across every office, exam and patient room, we're committed to providing individualized, holistic care. This is our Christian mission, and it inspires us to help make communities healthier and happier.

The role you will contribute : This position leads AdventHealth's Medicaid reimbursement process across the entire company focusing on supplemental Medicaid payments, provider taxes, Medicaid strategy development and implementation. Develops and implements company Medicaid strategy, both with leadership and key AdventHealth stakeholders, and with multiple outside consultants and experts. Acts as a consultant to leaders ensuring the Medicaid rate setting, payment, and reconciliation processes are accurate, complete, and aligned with cost reporting regulations. Responsible for calculating and recording the financial impacts related to these processes and reconciling those calculations with the local markets. Must be an expert in navigating and resolving audit findings with a variety of CPA & governmental auditors. Must possess knowledge in reimbursement including, but not limited to : Rural Hospitals, Critical Access Hospitals, DSH, Uncompensated Care, DGME, IME, Psych, Rehab, 340B and more. Is an important internal consultant to CFOs and strategic executives, routinely helping find and implement solutions that balance strategic imperative needs while maintaining compliance with the myriad regulations.

The value you will bring to the team :

• Serves as AdventHealth subject matter resource for Medicaid reimbursement matters. This role is focused on Medicaid payment areas.
• Leads a team of reimbursement professionals, providing guidance, training, and development opportunities.
• Maintain a strong working knowledge of current laws and regulations of the federal and state Medicaid programs
• Ensures data, payments, settlements, audits, and financial entries are completed.
• Communicate technical positions / arguments effectively to Medicaid auditors to support positions.
• Leverages reimbursement expertise to identify strategic opportunities supporting long-term reimbursement optimization and sustainability.
• Propose year end estimated Medicaid third party financial settlement to be audited by AdventHealths external auditor for inclusion in the audited financial statements.
• Proactively seeks to improve strategy and reduce risks. This includes managing outside consultants and engaging with hospital associations.
• Creates solutions in compliance with regulations
• Collaborates with key stakeholders to support the reimbursement initiative and to identify, plan and execute reimbursement strategy.
• Collaborates with other large system reimbursement leadership to identify best practices and incorporate learnings within the organization.
• Engages in continuous knowledge development regarding healthcare industry developments, best practices, tools and techniques.
• Responsible for ensuring that the potential of future take backs, is understood, communicated, and managed appropriately.
• Educates Finance, Revenue, Cycle & Operational Leaders on regulations & impacts
• Communicate with key stakeholders on opportunities and impact, both regarding current issues as well as fundamentals of reimbursement for those in new roles
• Strategic Thinking deployed identifying new reimbursement mechanisms, ensuring the proper development, management and optimization of existing programs (coordinate, grow, reduce risk) and identify when and whether to join appeal cases.
• Consults with leadership, providing guidance how to ensure stability of existing programs and strategic options to consider, to fulfill our mission
• Provides mentoring and coaching to staff, develops future financial leaders, recruits top-tier talent
• Utilizes excellent communication skills, including adjusting or adapting messaging for different stakeholders.
• Participates in and / or lead special projects as assigned.

DIRECT REPORTS

Medicaid Team

The expertise and experiences you'll need to succeed :

Bachelor's degree in accounting or finance

10 years of relevant experience in healthcare finance, preferably in reimbursement including Medicare, Medicaid reimbursement and regulatory cost reporting

Strong background in accounting and financial analysis

Strong and proven leadership skills

Expert in Medicaid program reimbursement laws and regulations

Ability to research and interpret Medicaid laws and regulations

Possesses a detailed understanding of governmental payment regulations and risks, applies that understanding to produce annual reporting, requests for reimbursement, and audit responses.

Possess an understanding of financial accounting and auditing principles and their application to healthcare

Strong analytical reasoning, critical thinking, judgment and problem-solving skills to independently assess, interpret and address complex issues in a continually changing environment

Effective written and verbal communication skills

Excellent interpersonal skills

Well organized and detail-oriented

Ability to understand complex healthcare financial revenue recognition, accounting, and finance models, including the relationship of costs and revenues

Communication skills to translate these complex models and clearly share those impacts with team members, peers, and leaders throughout the organization, making the complex simple, understandable, and actionable

Independent thinking, comfortable enough to challenge the assumptions of more senior leaders if those leaders need to consider other alternatives

Ability to collect data, perform analysis, organize and present the analysis and recommendations to management in written or oral format

Detailed understanding of GAAP (Generally Accepted Accounting Principles)

Ability to work in a fast paced and dynamic environment while meeting deadlines

Understands the need to continue learning, and actively seeks new learning opportunities

Able to interview & identify quality future team members

Certified Public Accountant (CPA)

Preferred Qualifications :

Master's degree in business administration or accounting

5 years of proven leadership skills in management role

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

Category : Accounting / Finance

Organization : AdventHealth Corporate

Schedule : Full-time

Shift : 1 - Day

Req ID : 25031067