Dir Reimbursement

Summary :

Under the general direction of Vice President of Contracting and Payor Relations is responsible for the preparation of all third-party reporting and revenue estimates related to Lifespan and affiliate reimbursement.

Direct control and supervise all reimbursement duties.

Responsibilities :

Prepare and assemble all financial and statistical individual affiliate and consolidated Lifespan reports required by third party and governmental agencies for Lifespan and affiliate reimbursements.

Analyze financial and statistical data used in the individual affiliate reimbursement reports to determine accuracy consistency from year to year and effects upon Lifespan reimbursements or final settlements.

Verify and analyze rate calculations submitted by third party payors and governmental agencies for accuracy.

Verify and analyze final cost settlements submitted by third party payors and governmental agencies for accuracy.

Coordinate third party audits defending preferential reporting practices.

Prepare calculations projecting estimated Medicare rates of reimbursement. Adjust balances in both balance sheet and profit and loss statement to reflect current liabilities to / from third party payors at affiliate and system level.

Analyze pass through payments as well as third party advances to determine if Lifespan and affiliates are being underpaid or overpaid.

Recommend and support areas where formal appeals to third party and governmental agencies are warranted.

Maintain contact and close working relationship with Lifespan's CPA firm and reimbursement consultants on reimbursement matters.

Prepare monthly revenue and net accounts receivable estimates for all Lifespan affiliates.

Prepare special reimbursement studies regarding new programs.

Keep Vice President of Contracting an Payor Relations informed on operations and events in the reimbursement area.

Establish and maintain procedures for Reimbursement area to assure system-wide comprehensive and accurate data collection in full compliance with state and federal regulations.

Establish and maintain procedures for accumulating accurate statistical data.

Keep abreast of all standards to assure compliance with orders or directives issued by duly constituted governmental / regulatory agencies or third party payors.

This covers such areas as financial reporting procedures federal wage-price guideline and development of data to meet proposed changes in governmental payment mechanisms.

• Interview hire and assign subordinate staff; provide guidance and counsel to subordinate staff; conduct periodic performance evaluations;
• recommend personnel actions; act as resource for staff; conduct periodic individual and / or group staff meetings; prepare and submit payroll;

provide and maintain subordinate staff development plans; develop standards for subordinate staff performance.

Maintain quality assurance safety environmental and infection control in accordance with established system policies procedures and objectives.

Participate in councils quality improvement teams and other such committees as required.

Perform other related duties as required.

Other information : BASIC KNOWLEDGE :

BASIC KNOWLEDGE :

Bachelor's Degree in Accounting Finance or related field or equivalent.

Comprehensive knowledge of accounting procedures technical and professional accounting skills financial and other operational systems to control data collection and reporting activities and understanding of data processing procedures and capabilities.

EXPERIENCE :

Minimum of 5 years experience as a Manager or Director with experience in Month End Close AR Valuation Bad Debt Settlement Roll-Forward Medicare Cost Report Preparation DSH Medical Education Appeals and Government relations.

Broad experience in spreadsheet and database management applications.

SUPERVISION :

Function has supervision responsibility for up to 10 full-time equivalent personnel.