Director of Reimbursement Operations

5 days ago

Rockford, Illinois, United States Mercy Health Full time
Job Summary

We are seeking a highly skilled and experienced Director of Reimbursement to join our team at Mercy Health. The successful candidate will be responsible for overseeing the reimbursement process, evaluating and developing processes to improve and maintain the integrity of revenue and reimbursement systems, and conducting quantitative analyses of financial and operational information affecting Mercy Health reimbursement and financial operations.

Key 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 Mercy Health's operational reimbursement efficiency.
  • Communicate effectively with Finance leadership and Executive Council members.
  • Ensure compliance with regulatory standards related to reimbursement.
  • Stay up to date with new reimbursement methodologies and establish relationships with outside consultants.
  • Develop 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

To perform this job successfully, the individual must demonstrate the following behavior expectations:

  • Quality: Follows policies and procedures, adapts to and manages changes in the environment, demonstrates accuracy and thoroughness, looks for ways to improve and promote quality, applies feedback to improve performance, and manages time and prioritizes effectively to achieve organizational goals.
  • Service: Responds promptly to requests for service and assistance, follows the Mercy Health 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.
  • Partnering: Shows commitment to the Mission of Mercy Health 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, and embraces teamwork and supports positive change.
  • Cost: Conserves organization resources, understands fiscal responsibility, works within approved budget, develops and implements cost-saving measures, and contributes to profits and revenue.
Requirements

The ideal candidate will have a Bachelor's degree in accounting or finance, with a CPA designation or a Master's degree in healthcare, business administration, or finance preferred. A minimum of five years of healthcare experience is required.

The successful candidate must be able to follow written and oral instructions, pass a Driver's License Check and/or Credit Check (for those positions requiring), and pass a WI Caregiver Background Check and/or IL Health Care Workers Background Check.

The work environment is quiet, and the occupational exposure is Category C - No partners in the specified job classification have occupational exposure.

The 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.

The special physical demands of the job include sitting, using hands to operate a keyboard repetitively, talking, and hearing, with occasional standing, walking, reaching, and lifting up to 25 pounds.

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