Senior Director - Reimbursement - FT - Days - MHS

Location:

Hollywood, Florida

At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience.

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 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.Plans and monitors staffing activities, including hiring, orienting, evaluating, disciplinary actions, and continuing education initiatives.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.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.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.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.

Competencies:

Education and Certification Requirements:

Bachelors (Required)

Additional Job Information:

Complexity of Work: Requires critical thinking skills, effective written and verbal communication, decisive judgment, and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate timely action. Thorough knowledge of Medicare, Medicaid and Tricare/Champus rules and regulations, correct coding and billing instructions.Thorough knowledge of third party audit techniques. Proficient in Microsoft Office products and Cost Reporting Software. Experience monitoring, accessing, and analyzing federal, state, and local laws and regulations. Experience with public speaking, including presenting educational sessions. Required Work Experience: Fifteen (15) years of progressively responsible experience within reimbursement, hospital billing, coding, claims management or a related area required. Other Information: Additional Education Info: Bachelor’s degree in Accounting,or Finance, or Business Administration, or in a job related field.

Working Conditions and Physical Requirements:

•  Bending and Stooping = 80%
•  Climbing = 40%
•  Keyboard Entry = 80%
•  Kneeling = 40%
•  Lifting/Carrying Patients 35 Pounds or Greater = 0%
•  Lifting or Carrying 0 - 25 lbs Non-Patient = 80%
•  Lifting or Carrying 2501 lbs - 75 lbs Non-Patient = 60%
•  Lifting or Carrying > 75 lbs Non-Patient = 0%
•  Pushing or Pulling 0 - 25 lbs Non-Patient = 80%
•  Pushing or Pulling 26 - 75 lbs Non-Patient = 60%
•  Pushing or Pulling > 75 lbs Non-Patient = 40%
•  Reaching = 80%
•  Repetitive Movement Foot/Leg = 0%
•  Repetitive Movement Hand/Arm = 80%
•  Running = 60%
•  Sitting = 80%
•  Squatting = 80%
•  Standing = 80%
•  Walking = 80%
•  Audible Speech = 80%
•  Hearing Acuity = 80%
•  Smelling Acuity = 60%
•  Taste Discrimination = 0%
•  Depth Perception = 80%
•  Distinguish Color = 80%
•  Seeing - Far = 80%
•  Seeing - Near = 80%
•  Bio hazardous Waste = 60%