Director Reimbursement

Summary

Description

Reports to the Controller. Directs the daily operational activities, reporting and control functions of assigned areas of Reimbursement.

Exhibits detailed knowledge of the underlying software systems necessary to effectively manage functionality available in the software.

Troubleshoots and resolve functional problems with the software utilized in the performance of activities. Serves as a liaison between management, third-party payors and auditors to educate management on reimbursement opportunities and trends while ensuring information needs are met.

Works closely with leadership of finance, financial planning and patient accounts to improve reimbursement by identifying opportunities for improvement through effective communication and collaboration.

MISSION, VALUES and SERVICE GOALS

• MISSION : We deliver outstanding care, inspire health, and connect with heart.
• VALUES : Trust. Respect. Integrity. Compassion.
• SERVICE GOALS : Personally connect. Keep everyone informed. Be on their team.

Responsibilities

Directs the daily activity and functions of assigned area(s) by :

• Developing short and long-term goals for the department through the analysis of job activities, selecting and measuring quality indicators and reporting quality improvement results.
• Providing ongoing support, maintenance and overseeing problem resolution maintenance of the software systems. Scheduling the workload of the staff in accordance with the priority guidelines set with the Controller.

Communicating with the Controller regarding any concerns or problems.

• Recruiting, screening / interviewing, selecting, evaluating, coaching and, when necessary, disciplining the staff.
• Providing ongoing technical guidance and assistance to the staff. Also planning and coordinating ongoing training and education for the staff and providing a comprehensive orientation for new staff.
• Providing education to staff on departmental policies / procedures and practices.
• Scheduling, assigning and monitoring the work of assigned staff to ensure quality and timeliness of work performed. Monitoring all projects and work assignments in progress and providing periodic status reports to the Controller.
• Reviewing the staff's work papers and output for accuracy and completeness.

Recommends and implements projects which will enhance the organization's performance in efficiency and accuracy for functions under the Reimbursement Department's control by :

• Identifying potential improvements.
• Collaborating with leadership
• Seeking approval on large projects, as appropriate.
• Assuming a lead role by recruiting key customers to participate in the planning, testing and implementation of projects.
• Ensuring implementation of the project.
• Provides challenges and growth opportunities to enhance leadership skill development to direct reports.

Supports the Department by :

• Conducting educational / informational programs as part of orientation or as requested.
• Troubleshooting software problems and assists the staff in determining the corrective actions to take to resolve the problem.
• Leading the department in the development of testing plans and the testing as software is upgraded or implemented.
• Seeking possible opportunities to more effectively utilize computer capabilities; also communicating with the Controller regarding these possible opportunities.
• Acting as a liaison and facilitator with other departments. Also communicating with appropriate management personnel from various departments regarding their business needs.

Takes proactive steps to ensure customer's needs are met.

Performs other functions to maintain personal competence and contribute to the overall effectiveness of the department by :

• Completing other job related assignments and special projects as directed.
• Implements initiatives in strategic plan.

ORGANIZATIONAL RESPONSIBILITIES

Associate complies with the following organizational requirements :

• Attends and participates in department meetings and is accountable for all information shared.
• Completes mandatory education, annual competencies and department specific education within established timeframes.
• Completes annual employee health requirements within established timeframes.
• Maintains license / certification, registration in good standing throughout fiscal year.
• Direct patient care providers are required to maintain current BCLS (CPR) and other certifications as required by position / department.
• Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self.
• Adheres to regulatory agency requirements, survey process and compliance.
• Complies with established organization and department policies.
• Available to work overtime in addition to working additional or other shifts and schedules when required.

Commitment to Beacon's six-point Operating System, referred to as The Beacon Way :

• Leverage innovation everywhere.
• Cultivate human talent.
• Embrace performance improvement.
• Build greatness through accountability.
• Use information to improve and advance.
• Communicate clearly and continuously.

Qualifications

Education and Experience

The level of knowledge, skills and abilities indicated below are normally acquired through the successful completion of a Bachelor's degree in, Accounting, Finance, or equivalent.

Requires a minimum of five years of professional experience in reimbursement or revenue cycle analysis and related governmental reporting.

Knowledge & Skills

• Requires knowledge of Medicare / Medicaid and third-party payer practices and procedures, cost report and wage index preparation, contractual analysis, and communications with auditors.
• Requires the knowledge and ability to model and analyze complex managed care contract and financial proposals while providing recommendations to maximize overall revenue yield from contracts.
• Demonstrates the knowledge and ability to analyze and model government payment mechanisms in manner that assists management in focusing on changes in both current and future payment.
• Requires the administrative and management skills necessary to organize and manage assigned areas of responsibility. Also demonstrates the leadership / management skills necessary to elicit cooperation and support from others.
• Requires the analytical skills necessary to develop, evaluate and administer policies, procedures and maintain staffing levels.
• Demonstrates advanced computer skills including relevant systems report writing (i.e., Cerner, Peoplesoft), word processing, spreadsheet, and database software.
• Requires the organization, planning, decision making, problem-solving and math skills necessary to plan and estimate project-related activities and time lines and identify and resolve problems and deliver viable solutions.
• Demonstrates the interpersonal and communication skills (both verbal and written) necessary to interact effectively with government and third party payors, and other associates.

Also requires the ability to develop and maintain effective working relationships.

Working Conditions

Works in an office environment.

Physical Demands

Requires the physical ability and stamina to perform the essential functions of the position.