Director, Reimbursement-Financial Analysis Reimbursement-Corporate 42nd Street-Full-Time-Days

Director, Reimbursement-Financial Analysis Reimbursement-Corporate 42nd Street-Full-Time-Days

The Director is responsible for direction and management responsibility over the business and operational activities of a department (overall department management or a specific area within a department), or medical care unit.

 

• Provides superior customer service to internal and external clients, customers, and patients as referenced in the Service Excellence Standards.    
• Oversees the preparation and submission of all regulatory reports.    
• Performs direct development and implementation of all NPSR, HSN, and governmental revenue activities including accruals, reserves, and settlements at the hospital levels.      
• Plans, coordinates, and prepares year end audits with public accounting firms and third party auditors as they relate to AR operations.    
• Mediates and resolves conflicts regarding public accounting firms, third party auditors, and investigative parties.    
• Ensures compliance with relevant regulations, standards, and directives from regulatory agencies and third party payers.    
• Collaborates with other leaders with Steward, external agencies, vendors, and partner organizations to achieve improved financial outcomes.    
• Acts as primary contact for all reimbursement issues and advises the financial management team about changes in reimbursement environment and suggest courses of action.
• Trains all new employees about reimbursement issues and system usage.    
• Evaluates of all medical education reimbursement calculations, which includes scrutinizing all roll forward calculations, affiliation agreements, and residency caps.      
• Reviews all Medicaid and Medicare data to determine Medicare disproportionate share reimbursement.
• Reviews all third-party settlements to ensure their accuracy and standardize their presentation.    
• Oversees the preparation and review of each hospital's monthly net revenue modeling and helps to evaluate variances to budget.
• Oversees all audits performed by external firms and/or governmental agencies.      
• Prepares responses to both internal and external questions involving various reimbursement matters to ensure a timely and accurate resolution to all issues.    
• Interacts with division directors and departmental heads to obtain all data necessary to comply with various regulatory requirements.
• Takes the lead role in reviewing the annual Medicaid RFA to evaluate its impact and coordinate the system's response.   
• Assists with the evaluation and resolution of various compliance matters involving federally funded insurers like Medicare and Medicaid.
• Oversees the process to identify Medicare + Choice plan discharges so that Medicare senior plan IME billing takes place timely.
• Participates in the evaluation of all managed care proposals to ensure that all proposals will enable the system to cover costs and can be administered effectively.
• Completes annual evaluations for all direct reports.
• Develops the departmental annual operating and capital budgets.
• Creates new policies and procedures resulting from system and/or operational changes.     
• Makes all decisions governing hiring, promoting, demoting, and terminating staff.      
• Oversees the creation of standardized reports and analyses used to evaluate all RFPs.

• Education: Bachelor's degree in either business or financial related field.  A Master's degree in business, finance, or health care related field is preferred.
• Experience: 7 years of experience in health care finance or administration; experience in strategic planning and execution, formulating policy, building and developing financial plans, managing resources and leading successful teams. Big 4 experience a plus. CPA a plus
   

 

Non-Bargaining Unit, 536 - Reimbursement - MSH, Mount Sinai Hospital

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