ASSOCIATE VICE PRESIDENT, REIMBURSEMENT

Location: Menomonee Falls, WI (Woodland Prime 400 facility) – Hybrid role

About the Role

The Associate Vice President, Reimbursement provides strategic and operational leadership for all reimbursement-related functions and processes. This system-level role acts as a trusted advisor to executive leadership on reimbursement matters, leading the reimbursement program and modeling, cost reporting, regulatory compliance, and advocacy efforts. The position partners across the system with finance, revenue cycle, government relations, managed care, office of general counsel, and operational leaders to optimize reimbursement, ensure regulatory compliance, and support long-term financial sustainability.

Responsibilities

• Lead modernization of the reimbursement program, emphasizing automation and process improvement initiatives to reduce manual work and enhance analytics.
• Ensure timely and accurate preparation of annual Medicare/Medicaid cost reports for all affiliate hospitals, including the parent Home Office cost report.
• Coordinate the annual Medicare audit and any special audits, including related correspondence.
• Proactively recommend operational changes to optimize reimbursement in compliance with regulations.
• Lead preparation and analysis of contractual allowances, bad debt, and third-party liabilities on a monthly basis.
• Ensure accounts receivable and third-party liabilities are valued and reserved appropriately on the balance sheet.
• Deliver clear, concise variance explanations throughout the year.
• Review contractual allowances, bad debt allowances, and third-party liabilities reserves with external auditors for the system.
• Build strong relationships and provide support to:
  • Senior VP of Finance and CFO of the system, liaising with the Wisconsin Hospital Association (WHA) for third-party reimbursement matters.
  • The system Governmental Relations Office, representing the system in matters impacting hospitals at the county, state, and national levels.
  • The system Office of General Counsel on Medicare and Medicaid regulation, particularly compliance-related matters.
• Conduct reimbursement modeling and analyses to ensure optimization of reimbursement from all payers and assess the optimality of current payment methodologies.
• Coordinate and record all financial activity of the hospitals in support of various Medical College of Wisconsin (MCW) departments.
• Analyze the cost to full-time equivalents (FTE) of supporting medical education and its financial impact on hospital operations.
• Monitor medical education costs and reimbursements, including providing support to FT’s Medical Officers on annual hospital budgets.
• Coordinate third-party reimbursement activities for FT, including:
  • Interacting with CMS or its intermediaries.
  • Recommending operational changes to ensure compliance with federal and state regulations.
  • Performing analyses and audits of accounts receivable and third-party liabilities.
  • Researching reimbursement matters for executive management.
  • Interpreting promulgations from governmental bodies for executive management.
• Provide input on all reimbursement matters and assist in preparing the annual operating and capital budgets for FT.
• Assist in the annual update of the five-year operating and capital plan.
• Maintain and support the decision support system reimbursement module, including loading and reviewing governmental and non-governmental contract payer information.
• Serve as the main contact in Finance for disclosing financial data in community benefit reporting.
• Play an active role in the Milwaukee Health Partnership in financial data reporting and maintaining consistency across systems.

Requirements

• Minimum of 7 years of experience in Medicare, Medicaid, managed care, and other reimbursement methodologies.
• Bachelor’s Degree in Business Administration with an emphasis in Accounting or Finance (required).
• MBA (preferred).
• CPA (preferred).

Benefits

• Paid time off.
• Growth opportunities, including Career Pathways, Career Tuition Assistance, and CEU opportunities.
• Academic partnership with the Medical College of Wisconsin.
• Referral bonuses.
• Retirement plan (403b).
• Medical, dental, vision, life insurance, and short & long-term disability coverage.
• Free workplace clinics.
• Employee Assistance Programs.
• Adoption assistance.
• Healthy Contributions.
• Care@Work (childcare/eldercare support).
• Moving assistance.
• Discounts on gym memberships, travel, and other work-life benefits.

Schedule

• Full-time (1.00 FTE).
• Standard hours: 40.00 per week.
• Shift: Shift 1.