Director, Government Reimbursement

About the role

Position will provide primary leadership and support to the Governmental Reimbursement function for UC Health. Primary areas of focus will include governmental hospital cost report review and oversight of preparation, home office cost report preparation, HCAP filings and audit, key contact for the Medicare Administrative Contractor (MAC) oversight with primary management of audit submission deadlines and assignment of tasks, work with consultants/auditors to resolve reimbursement issues and present on strategic planning advice to senior leaders for the organization and hospital sites.

Responsibilities

• Cost Reporting
  • Supervise the preparation and review of governmental cost report filings, including management of outside consultants
  • Track and report out on status updates, obstacles and projects plans to ensure timely completion of all regulatory filings
• Internal Functional Resource
  • Act as lead system liaison to fiscal intermediaries and carriers pertaining to audits, appeals and negotiations, coordinating assignment of tasks and deadline driven submissions
• Strategic Planning
  • Review and interpret legislative changes to governmental reimbursement programs and provide routine updates to system leadership groups
  • Provide direction on government reimbursement related issues and questions, quantifying the impact of clinical and strategic program proposals
  • Provide analysis and direction to annual operating budget and input on all relevant governmental reimbursement assumptions and activity
  • Work with outside auditors and consultants to resolve reimbursement issues and provide strategic planning guidance relative to governmental reimbursement and future trends
  • Track and report out on status updates, obstacles and project plans to ensure timely completion of all regulatory filings
• State Directed Payment Functions
  • HCAP filings
    • Direct the government reimbursement team in data pulls and timely submission of state required HCAP filings and audits
  • The review of the Hospital Franchise Fee (HFF), Hospital Additional Payments (HAP), and HCAP assessment amounts and the internal processing of the assessment amounts in a timely manner to the appropriate personnel
  • Monitor Ohio Hospital Association (OHA) communications on a regular basis that pertains to HCAP, HAP, and HFF assessments and payments
  • These are to be shared with the appropriate personnel for budget forecasts, revised monthly expense accruals, and cash management
• Staff Management
  • Train, supervise and hire staff
  • Aid in the resolution of personnel issues for all areas including hiring, terminating and disciplining associates
  • Ensure necessary training and development for staff is provided and monitor performance progress, including annual staff evaluations
• Corporate Finance Interactions
  • Review governmental third-party liability accounts after guiding team members through completion
  • Cook up regulatory driven components of system’s annual community benefit reporting

Qualifications

• Minimum Required: Bachelor's Degree in Business Administration (Accounting/Finance-Preferred)
• Preferred: Master's Degree; MBA
• Preferred: 6 - 10 Years equivalent experience