Corporate Director, Reimbursement

Description

The Corporate Director, NPSR & Reimbursement is a significant leadership role within Emory Healthcare to drive operational and financial effectiveness within the governmental reimbursement and net patient revenue function of a complex health system. This role will work closely with hospital operations, clinical departments, and the finance team to oversee the financial reporting associated with the governmental reimbursements and required cost reporting compliance.

 

• Oversee analysis and reporting for Governmental Reimbursements for Emory Healthcare and valuation of the accounts receivable across Emory Healthcare for all hospital and physician billing operations.
• Responsible for reviewing cost reports, monitoring compliance with CMS regulations, attestations, and preparing to report on all supplemental Federal and State reimbursement matters.
• Coordinates Medicare and Medicaid audits and assists with preparation of all supporting work papers and documentation across Emory Healthcare and identify trends to develop insights to improve governmental reimbursements.
• Responsible for Medicare Administrative Contractor (MAC) correspondence and interim rate setting to ensure accurate reimbursement and compliance with regulations.
• Reviews and coordinates preparation of the annual State of Georgia, DCH Reports, including DSH, GME, Hospital Financial Survey (HFS) and Indigent Care Trust Fund Survey (ICTF), as well as potential future funding opportunities.
• Responsible for graduate medical education reporting and provides organizational guidance to maximize reimbursements.
• Responsible for annual system-wide net revenue budget with operational leaders and provide actual, budgeted, and projected net patient service revenue using data sourced from the general ledger and Epic.
• Work collaboratively with other departments and divisions related to net revenue management activities.
• Oversees detailed research and analysis of client reimbursement issues, reviews reports on healthcare reimbursement trends as well as monitor industry trends and changes in reimbursement policies.
• Review and provide analysis to ensure accuracy of reimbursement rates and modeling financial impact.
• Enhances and improves analysis to determine the impact of payer mix and changes to operations on governmental reimbursements and net patient revenue.
• Monitors changes in Federal and State regulations affecting the healthcare industry and prepares analysis as it relates to third-party reimbursement and net patient service revenue impacts.
• Reviews and assists with strategic pricing analysis in association with the annual budget for charge master pricing and net revenues.
• Develops year-end audit documentation; reviews and oversees detailed schedules and analysis to support financial statements. Works with external and internal auditors to interpret schedules and resolve discrepancies.
• Develops control procedures and assists in the development of new procedures to improve internal control measures.
• Provides recommendations to management.
• Identifies and reviews analysis involving new business initiatives and models governmental reimbursement impacts.
• Creates recommendations on policy issues to maintain compliance with regulations and guidelines.
• Enhances and is proactive in implementing procedures consistent with established policies.
• Supervises and analyzes current policies and procedures and assesses effectiveness.
• Oversees and manages special projects.
• Oversees the preparation of special impact studies and other financial surveys and questionnaires.
• Ensures professional development and attends educational in-services as appropriate.
• Participates in professional activities and organizations to maintain knowledge of current trends, practices, and developments.
• Reviews, prepares and analyzes statistical reports, financial statements, and supporting schedules for management.
• Identifies, develops, and implements methods for improving reporting efficiency.
• Identifies requirements and develops reports required by state and federal agencies and ensures compliance.
• This position ensures accurate and timely revenue recognition and calculating the estimated reimbursements for Emory Healthcare.
• Provides guidance and direction to professional staff.
• Performs related responsibilities as required.

MINIMUM QUALIFICATIONS:

• Bachelor's degree in accounting, business, economics, math, or a related field
• Seven or more years of directly-related experience
• Six or more years of experience in revenue/accounts receivable financial analysis, claims or billing analysis, decision support, or economics in a healthcare setting
• Six or