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Director of Reimbursement

2 months ago

Rockford, United States Mercy Health Full time
Overview

Responsible for overseeing Finance reimbursement activities for system. Evaluate and develop processes for improving and maintaining the integrity of revenue and reimbursement systems. Conduct quantitative analyses of financial and operational information affecting Mercyhealth reimbursement and financial operations. Reviews data and develops reports and other tools to identify areas for operational efficiency and improvement and to set and track benchmarks. Effectively manages change and has the ability to implement operational improvements in an Integrated Delivery System. Performs other duties, as assigned.

Responsibilities

ESSENTIAL DUTIES AND RESPONSIBILITIES

  • Evaluate and determine appropriate reimbursement levels for all entities of the organization.
  • Participate in month-end functions, annual audit, budget development and other routine reimbursement activities.
  • Coordinate annual cost report submissions and audits for the system.
  • Manage finance operations to support operational analysis and performance excellence. Develop processes or tools to monitor and evaluate identified financial and operational opportunities.
  • Develop and disseminate new measures and reports to monitor and improve Mercyhealth's operational reimbursement efficiency, drawing on established principles of financial analysis, cost accounting, process evaluation, and external benchmarking.
  • Communicates effectively with Finance leadership and Executive Council members.
  • Insures compliance with regulatory standards related to reimbursement.
  • Stays up to date, researches and models new reimbursement methodology.
  • Establishes relationships with outside consultants.
  • Develops a detailed understanding of billing transactions that affect AR and reimbursement.
  • Coordinate special projects related to improved processes within the reimbursement area and other areas of Finance.

CULTURE OF EXCELLENCE BEHAVIOR EXPECTATIONS

To perform the job successfully, an individual should demonstrate the following behavior expectations:

Quality - Follows policies and procedures; adapts to and manages changes in the environment; Demonstrates accuracy and thoroughness giving attention to details; Looks for ways to improve and promote quality; Applies feedback to improve performance; Manages time and prioritizes effectively to achieve organizational goals.

Service - Responds promptly to requests for service and assistance; Follows the Mercyhealth Critical Moments of service; Meets commitments; Abides by MH confidentiality and security agreement; Shows respect and sensitivity for cultural differences; and effectively communicates information to partners; Thinks system wide regarding processes and functions.

Partnering - Shows commitment to the Mission of Mercyhealth and Culture of Excellence through all words and actions; Exhibits objectivity and openness to other's views; Demonstrates a high level of participation and engagement in day-to-day work; Gives and welcomes feedback; Generates suggestions for improving work: Embraces teamwork, supports and encourages positive change while giving value to individuals.

Cost - Conserves organization resources; Understands fiscal responsibility; Works within approved budget; Develops and implements cost saving measures; contributes to profits and revenue.

EDUCATION & EXPERIENCE

Bachelor's degree in accounting or finance. CPA designation or Masters degree in healthcare, business administration, or finance is preferred. Minimum of five years healthcare experience.

ADDITIONAL REQUIREMENTS (Please do not remove this or edit this)

Passing the Driver's License Check and/or Credit Check (for those positions requiring).

Passing the WI Caregiver Background Check and/or IL Health Care Workers Background Check.

Must be able to follow written/oral instructions.

WORK ENVIRONMENT

The noise level in the work environment is usually quiet

Occupational Exposure: Category C - No partners in the specified job classification have occupational exposure.

INFORMATION ACCESS

Partner may access patient care information, financial data, human resource data and strategic and planning data needed to perform their job duties as directed by the director.

WORK CONTACT GROUP

Executive management, partners, physicians, patients/family, visitors, vendors, consultants

SPECIAL PHYSICAL DEMANDS

The Special Physical Demands are considered Essential Job Functions of the position with or without reasonable accommodations.

While performing the duties of this Job, the employee is regularly required to sit; use hands to operate a keyboard repetitively, talk, and hear. The employee is occasionally required to stand; walk; reach with hands and arms and stoop, kneel, crouch, or crawl. The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision and ability to adjust focus, particularly as it relates to computer screens.

LEVEL OF SUPERVISION

Manages reimbursement/financial analysts in the Finance Department. Is responsible for the overall direction, coordination, and evaluation of subordinates. Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

SUPERVISES

Directly supervises reimbursement and financial analysts. Supervisory responsibilities are conducted in accordance with directives of management, the organization's policies, and applicable laws.