Senior Director Reimbursement - DUHS

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General Description

This position leads all governmental reimbursement functions at Duke University Health System and is therefore responsible for compliance, analysis, revenue optimization, advocacy and communication on all related matters. Given the position of DUHS as a leader in state, regional and national care delivery, this position will be expected to lead in the development of regulations, policies and practices at all levels.

 

In addition, the position:

• has overall responsibility for compliant compilation, submission and defense through final settlement of annual Medicare, Medicaid, Tricare and other external Cost Reports for Duke University Health System, Inc. (Home Office), Hospitals, and related entities.  
• is responsible for appropriate completion of all audit / desk review analysis and required responses to auditor inquiries as well as complete and compliant Cost Report re-openings and appeals.  
• assesses Health System participation in Cost Report-related litigation and, as applicable, ensures the Health System participates in appeal matters necessary to appropriately protect the Health System’s position to secure future reimbursement.    
• maintains direct contact with various Duke University Health System and Hospital entities to optimize governmental reimbursements in compliance with the governmental guidelines.
• Develops and leads a team of professionals experienced in this highly-specialized and regulated work environment, with a focus on team culture as well as each individual’s development and work satisfaction.
• represents DUHS in consultations with the NC Medicaid program around reimbursement programs, including supplemental or direct payment programs; coordinates with CFOs of other major North Carolina health systems, North Carolina Healthcare Association and outside counsel to ensure proposals support the interests of Duke Health and academic medicine.

 

Duties and Responsibilities of this Level

 

• Responsible for the timely submission of compliant governmental reporting including:
  • Annual Medicare, Medicaid and Tricare Cost Reports
  • Medicare, Medicaid, Tricare Appeals and Re-opened Cost Reports
  • Wage Index and Occupational Mix submissions
  • NC Supplemental DSH and Rate Eligibility
  • Audit and Desk Review responses
• Responsible for all aspects of appeal considerations and Cost Report-related reimbursement litigation.
• Ensures the Cost Report compilation process is consistent with Health System strategies, policies and procedures including:
  • Access to appropriate compilation software and analytical support systems to ensure timely and compliant reporting.
  • Maintain relationships with Health System and Hospital contacts to ensure appropriate communications and access to required source documentation.
  • Oversee all aspects of the annual compilation efforts.
  • Maintain access to Health System entities and contacts to ensure efficient access to required documentation and data and optimize Cost Report reimbursements.
  • Oversee vendor contracts where appropriate to optimize reimbursement.
  • Oversee the processes for compliant periodic, annual governmental and ad hoc reporting.
  • Maintain lines of communication with governmental entities.
  • Oversee all aspects of compilation procedures and systems that will ensure appropriate and compliant reporting.
• Responsible for budget and actual governmental settlement accounts including revenue deductions, contractual allowances, settlement account estimates and other reserves.
• Provide support and calculations to operations for business plans, contracting or other changes within Duke Health.
• Provide timely and accurate analysis related to proposed or implemented changes to reimbursement or coverage at state or federal level.
• General:
  • Responsible for developing the strategies, policies and procedures for Health System Reimbursement.
  • Responsible for maintaining knowledge of support system operations, federal and state guidelines, ensuring Reimbursement Team is similarly knowledgeable of and preparing required supporting compilation documentation in compliance with applicable laws and guidelines.
  • Represent positively Health System Reimbursement to external audiences at conferences, presentations, workshops, association meetings, etc.
  • Perform other assigned responsibilities and projects as delegated by the Vice-President - Finance.