Employment Type:

Full time

Shift:

Description:

POSITION PURPOSE

The Regional Director of Reimbursement serves as the primary contact to the Regional Chief Financial Officer along with the Regional Health Ministry (RHM) Vice Presidents of Finance and the Regional Ambulatory Services Leadership to provide them with an understanding of their business, net revenue estimates, balance sheet valuations, net revenue budgets, mid-month projections and regulatory changes. The role provides critical help to the Vice Presidents of Finance in understanding their business so appropriate and timely decisions can be made.  The incumbent provides leadership to a Regional Shared Service Center managing the reimbursement function for up to ten Trinity Health RHMs (with net revenues of $2 billion annually). The position is responsible for managing and mentoring all Shared Service Center managers and staff and is also required to manage the relationships between the Shared Service Center and RHM Vice Presidents of Finance.

This position identifies and manages all financial and compliance risk associated with the reimbursement function, keeping senior leadership apprised of identified risk and tracks progress with risk management plans.  It works closely with and supports other revenue functional areas including payer negotiations and contracting, patient financial services, utilization management and coding. It serves in an advisor capacity to RHMs in region and to the Reimbursement and Revenue Integrity Central Operations Team.  The role identifies and implements leading practices, processes and technology necessary to achieve objectives and engage key stakeholders by leading effective change management.  Responsible for leading and participating in initiatives to improve net revenues, reduce receivables and improve compliance associated with the Southeast Michigan professional (ambulatory) services.

ESSENTIAL FUNCTIONS

• Knows, understands, incorporates and demonstrates the Trinity Health Mission, Vision and Values in leadership behaviors, practices and decisions.

• Prepares the department budget and manages use of resources within budget targets.

• Responsible for hiring, retaining, evaluating, mentoring and firing managers and staff within the department.

• Responsible for managing all financial and compliance risk associated with the reimbursement function (for acute and professional services), notifying senior leadership of identified risks and tracking and monitoring progress of risk management plans.

• Directs the preparation of RHM net revenue calculations and reviews with the Vice Presidents of Finance prior to financial statement due date. Directs the preparation of the budgeted net revenue calculation for the RHMs.

• Manage the overall balance sheet position related to third party contractuals and related reserves.  Provide updates to Senior Leadership to avoid any surprises.

• Directs the preparation of RHM cost reports and other third-party filings.  Directs the preparation for third party audits and takes a lead role in resolving audit issues and developing appeals. Directs the preparation of reports, position papers, impact analysis and development of recommendations concerning specific reimbursement issues. Participates in developing group appeals for all Trinity Health concerning reimbursement disputes with third party payors.

• Develops strategic reimbursement planning and analysis for short and long-term operating plans and capital projects (for acute and professional activities). 

• Provides financial planning assistance to Regional Chief Financial Officer and RHM Vice Presidents of Finance and Ambulatory leadership relative to current reimbursement practices and proposed changes in both the public and private sectors and provides the Leadership with the latest updates on changes in reimbursement regulations. Provides direction in the development of reimbursement strategies that reflect changes in the reimbursement environment.

• Develops and implements policies and procedures to ensure reimbursement procedures, practices and reporting adhere to compliance regulations.

• Directs reporting process and reconciliation of general ledger accounting for third party payments and settlements, including third party payor receivables, payables and reserves.  Responsible for matters which include areas of policy development and ongoing reporting.

• Provides education and consultation to staff to ensure accuracy of third party reporting.  Maintains expertise in reimbursement strategies through appropriate educational and organization activities.

• Directs year end audit preparation for reimbursement issues ensurin