System Director, Revenue and Reimbursement Integrity

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Job description

Cielo Talent is currently conducting an executive search for a System Director, Revenue and Reimbursement Integrity on behalf of our client, Health First. Health First is the only integrated delivery network (IDN) in Central Florida.

POSITION SUMMARY

The System Director, Revenue and Reimbursement Integrity will be accountable for the accounting, forecasting, financial analysis, prevention of losses, and reporting of revenue and reimbursement for Health First and its affiliates. Collaborate with other responsible parties in the organization by taking an active role in the revenue cycle process. Direct and manage staff, ensuring accuracy of financial reporting (AHCA, Cost Reports, etc.).

PRIMARY ACCOUNTABILITIES

• Maintain a strong knowledgebase on proposed hospital payment regulations.
• Work in collaboration with appropriate internal and external parties to evaluate, negotiate, and enforce managed care contracts.
• Provide credible and understandable financial analysis and guidance that enhances decision making, to preserve and enhance the financial position and performance of Health First.
• Direct and review the preparation of the Medicare/Medicaid cost reports. Analyze and propose methods to receive correct Hospital revenues from cost reports. Coordinates cost report audits with Fiscal Intermediary auditors.
• Direct the preparation and calculation of contractual adjustments and third-party reserves for the preparation of monthly financial statements, forecasts, and audits. Oversee the methodology and records, to support contractual adjustment calculations.
• Assist with revenue rate setting and contractual adjustment analysis, in conjunction with forecasting and the long-range financial plan of Health First.
• Perform annual evaluation of impact of proposed and final Medicare, Medicaid, and other third-party reimbursement changes.
• Research, prepare and file rate requests and appeals related to reimbursement issues with third parties.
• Direct prior year cost report receivables/payables, including review and recommendation of proposed third party audit adjustments.
• Ensure that overpayments and underpayments from third party payers are accounted for accurately.
• Work with appropriate leadership to ensure that payments due to and due by hospital are correctly handled.
• Lead and direct the value-based purchasing initiatives of the organization.
• Monitor governmental reimbursement regulation changes, while working with senior leadership to ensure organizational compliance with payer regulations that enable the organization to prepare for reimbursement changes and to optimize payments as appropriate.

MINIMUM QUALIFICATIONS

Education:

• Bachelor's Degree in business or related field from an accredited college or university
• MBA and CPA Preferred

Work Experience:

• 10 years' experience in healthcare related environment with a concentration in hospital revenue and reimbursement analysis.
• Experience in cost reporting and charge master.
• 5 years of management and leadership experience

Knowledge/Skills/Abilities:

• Demonstrates strong management, supervision, motivation, and leadership ability
• Strong knowledge of reimbursement practices
• Prior experience and knowledge in the use of Microsoft Office products
• Possess the skill to operate computer and various computer software programs
• Demonstrates ability for problem solving, and able to think creatively and analytically
• Ability to prioritize and organize to maximize quality, value, and service
• Demonstrates effective oral, written, and interpersonal communication skills
• Ability to relate well with customers and staff