Senior Director - Reimbursement - Memorial Healthcare System : Job Details

Summary:

The Senior Director of Reimbursement develops and implements departmental goals, plans, standards, policies and procedures for managing governmental reimbursement and for ensuring timely and accurate cost reporting, consistent with the clinical, administrative, legal, and ethical requirements/objectives of Memorial Healthcare System (MHS). Responsible for systemic approaches that contribute improvements in Medicare and Medicaid funding, including designing, supporting, and implementing payment innovations.

Responsibilities:

• Oversees Corporate Finance functions for State Medicaid Agency reporting (Florida Hospital Uniform Reporting System, Inpatient and Emergency Department/Ambulatory Surgery Quarterly Reports, Low Income Pool and Disproportionate Share Hospital reports) to ensure timely and accurate reporting.
• Develops strategies for improving payment from various governmental programs in compliance with all relevant rules and regulations. May include operational changes, creation of new payment models, tracking detailed data reporting, or other approaches to apply governmental payment rules to MHS' advantage.
• Participates in governmental relations activities relevant to Medicare, Medicaid and other reimbursement programs. Acts as a subject matter expert resource to Executive management and external advocacy firms for all things related to governmental payors.
• Supports department leaders in developing and implementing operational responses to new governmental regulatory requirements affecting charges, billing, payment and related issues as they relate to reimbursement. Includes assistance with financial pro forma models, explanation of relevant payment, coverage, licensure, enrollment, and other requirements for governmental reimbursement, and presentation of relevant alternatives.
• Plans and monitors staffing activities, including hiring, orienting, evaluating, disciplinary actions, and continuing education initiatives.
• Oversees the Memorial Healthcare System cost reporting and reimbursement team to ensure timely and accurate statutory reporting. This also includes Medicaid supplemental payment program reporting., interim reporting, filed reports, audits, appeals, and reopenings.

Education and Certification Requirements: Bachelors (Required)

Required Work Experience: Fifteen (15) years of progressively responsible experience within reimbursement, hospital billing, coding, claims management or a related area required.