Dir Net Revenue & Reimb
Dir Net Revenue & Reimb
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Job Description
Overview
Director of Net Revenue & Reimbursement Accounting and Finance
Full Time 80 Hours Per Pay Period Day Shift
Covenant Health Overview:
Covenant Health is the regions top-performing healthcare network with 10hospitalsoutpatient and specialtyservicesandCovenant Medical Group our areas fastest-growing physician practice division. Headquartered in Knoxville Covenant Health is a community-owned integrated healthcare delivery system and the areas largest employer. Our more than 11000 employees volunteers and 1500 affiliated physicians are dedicated to improving the quality of life for the more than two million patients and families we serve every year. Covenant Health is the only healthcare system in East Tennessee to be named a Forbes Best Employer seven times.
Position Summary:
The Director of Net Revenue & Reimbursement is responsible for leading Covenant Healths reimbursement strategy across all payors including Medicare Medicaid/TennCare and commercial insurers. This role ensures accurate regulatory filings strategic alignment with managed care contracts and effective collaboration with the Billing Office to optimize revenue cycle operations and financial performance.
Recruiter:
Responsibilities
Medicare & Medicaid Reimbursement Oversight
- Lead all phases of Medicare cost reporting: preparation review filing audit response amendments and appeals.
- Oversee Medicaid/TennCare filings and ensure compliance with state-specific requirements.
- Manage annual JAR filings and other external surveys.
- Collaborate with internal teams to ensure accurate data submission for TennCare supplemental fund allocation.
Regulatory Compliance & Reporting
- Monitor and interpret CMS and TennCare regulations ensuring timely updates to internal processes.
- Develop tools and systems to capture and report Medicare Medicaid/TennCare and other governmental data.
- Coordinate with external consultants on DSH SSI S-10 Wage Index and 340B-related matters.
Revenue Cycle & AR Management
- Oversee AR template processes and ensure accurate contractual reserve calculations.
- Collaborate with Financial Analytics Business Office and IT to resolve data integrity issues and improve reporting systems.
- Support independent audits and ensure accurate third-party settlement calculations
Managed Care Collaboration
- Act as an intermediary between the reimbursement and managed care teams to align financial strategies with payer contracts.
- Provide insights into payment trends and rate changes and ensure accurate application of CMS published rates.
Payor Strategy & Billing Office Collaboration
- Maintain comprehensive knowledge of all payor types including Medicare Medicaid/TennCare commercial insurers and managed care organizations.
- Analyze payor mix trends and reimbursement methodologies to inform strategic financial planning.
- Collaborate closely with the Billing Office team to ensure accurate charge capture billing practices and timely resolution of reimbursement issues.
Leadership & Strategic Planning
- Supervise and mentor Reimbursement and AR template analysts ensuring access to current regulatory information and tools.
- Develop and implement departmental work plans and performance evaluations.
- Communicate reimbursement impacts and legislative changes to executive leadership.
- Follows policies procedures and safety standards. Completes required education assignments annually. Works toward achieving goals and objectives and participates in quality improvement initiatives as requested.
- Performs other duties as assigned.
Qualifications
Minimum Education:
Bachelors degree in Accounting Finance Healthcare Administration or related field.
Minimum Experience:
Minimum 7 years of experience in hospital reimbursement or revenue cycle management with at least 3 years in a leadership role.
Licensure Requirement:
None.
Employment Type
Full-Time
