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 hospitals 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 systems 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: Bachelors degree in either business or financial related field. A Masters 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