Director of Reimbursement

Responsibilities

• Prepare and assemble all financial and statistical individual, affiliate, and consolidated Brown University Health reports required by third party and governmental agencies for Brown University Health and affiliate reimbursements.
• Analyze financial and statistical data used in the individual affiliate reimbursement reports to determine accuracy, consistency from year to year, and effects upon Brown University Health reimbursements or final settlements.
• Verify and analyze rate calculations submitted by third party payors and governmental agencies for accuracy.
• Verify and analyze final cost settlements submitted by third party payors and governmental agencies for accuracy.
• Cook third party audits, defending preferential reporting practices.
• Prepare calculations projecting estimated Medicare rates of reimbursement.
• Adjust balances in both balance sheet and profit and loss statement to reflect current liabilities to/from third party payors at affiliate and system level.
• Analyze pass through payments as well as third party advances to determine if Brown University Health and affiliates are being underpaid or overpaid.
• Recommend and support areas where formal appeals to third party and governmental agencies are warranted.
• Maintain contact and close working relationship with Brown University Health's CPA firm and reimbursement consultants on reimbursement matters.
• Prepare monthly revenue and net accounts receivable estimates for all Brown University Health affiliates.
• Prepare special reimbursement studies regarding new programs.
• Keep Vice President of Contracting and Payor Relations informed on operations and events in the reimbursement area.
• Establish and maintain procedures for Reimbursement area to assure system-wide comprehensive and accurate data collection in full compliance with state and federal regulations.
• Establish and maintain procedures for accumulating accurate statistical data.
• Keep abreast of all standards to assure compliance with orders or directives issued by duly constituted governmental/regulatory agencies or third party payors.
• Maintain quality assurance, safety, environmental, and infection control in accordance with established system policies, procedures, and objectives.
• Participate in councils, quality improvement teams, and other such committees as required.

Qualifications

• Bachelor's Degree in Accounting, Finance, or related field or equivalent.
• Comprehensive knowledge of accounting procedures, technical and professional accounting skills, financial and other operational systems to control data collection and reporting activities, and understanding of data processing procedures and capabilities.
• Minimum of 5 years experience as a Manager or Director with experience in Month End Close, AR Valuation, Bad Debt, Settlement Roll-Forward, Medicare Cost Report Preparation, DSH, Medical Education, Appeals and Government relations.
• Broad experience in spreadsheet and database management applications.