Vice President - Reimbursement and Revenue Integrity - Memorial Healthcare System
Hollywood, FL
About the Job
Location:
Hollywood, Florida
At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience.
Summary:
Develops and implements departmental goals, plans, standards, policies and procedures for managing governmental reimbursement and for ensuring timely and accurate capture of patient charge information, consistent with the clinical, administrative, legal, and ethical requirements/objectives of the organization. Responsible for systemic approaches that contribute to the capture, management, and collection of patient service revenue. Enhances a properly functioning revenue cycle process through a cross-department organizational structure.
Responsibilities:
Supports and manages the technical charge capture systems, processes and workflows of revenue generating departments for the organization to ensure timely and accurate recording of revenue, in accordance with all applicable governmental and institutional standards, bylaws, rules and regulations. Provides information to charge capture teams and operational directors/managers related to mechanisms of charge triggers, controls and reconciliation, and coding for purposes of compliant billing and charging procedures.Oversees Corporate Finance functions for State Medicaid Agency reporting (Florida Hospital Uniform Reporting System, Inpatient and Emergency Department/Ambulatory Surgery Quarterly Reports, Low Income Pool & Disproportionate Share Hospital reports) to ensure timely and accurate reporting.Supports department leaders in developing and implementing operational responses to new governmental regulatory requirements affecting charges, billing, payment and related issues as they relate to reimbursement. Includes assistance with financial pro forma models, explanation of relevant payment, coverage, licensure, enrollment, and other requirements for governmental reimbursement, and presentation of relevant alternatives.Develops strategies for improving payment from various governmental programs in compliance with all relevant rules and regulations. May include operational changes, creation of new payment models, tracking detailed data reporting, or other approaches to apply governmental payment rules to Memorial Healthcare System's (MHS) advantage.Participates in governmental relations activities relevant to Medicare, Medicaid and other reimbursement programs. Acts as a subject matter expert resource to Executive management and external advocacy firms for all things related to governmental payors.Oversees the MHS cost reporting and reimbursement team to ensure timely and accurate statutory reporting. This also includes Medicaid supplemental payment program reporting. Interim reporting, filed reports, audits, appeals, and reopenings are in this scope of responsibility.Plans and monitors staffing activities, including hiring, orienting, evaluating, disciplinary actions, and continuing education initiatives.Oversees the MHS 340B process to ensure compliant participation and optimal pharmacy discounts. Participates as a member of the 340B Oversight Committee. Supports the 340B team's efforts to expand access to pricing discounts. Considers 340B eligibility impact of cost report related strategies.
Competencies:
Education and Certification Requirements:
Bachelors (Required)
Additional Job Information:
Complexity of Work: Requires critical thinking skills, effective communication decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate timely action. Essential to have thorough knowledge of Medicare, Medicaid and Tricare/Champus rules and regulations, correct coding and billing instructions. Essential to have thorough knowledge of third party audit techniques. Proficient in Microsoft Office products and Cost Reporting Software. Required Work Experience: Ten (10) years of progressively responsible experience within reimbursement, hospital billing, coding, claims management or a related area required. Experience monitoring, accessing, and analyzing federal, state, and local laws and regulations. Experience with public speaking, including presenting educational sessions. Other Information: Additional Education Info: Bachelor's degree in Accounting, Finance, Business Administration, or in a job related field.
Working Conditions and Physical Requirements:
Hollywood, Florida
At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience.
Summary:
Develops and implements departmental goals, plans, standards, policies and procedures for managing governmental reimbursement and for ensuring timely and accurate capture of patient charge information, consistent with the clinical, administrative, legal, and ethical requirements/objectives of the organization. Responsible for systemic approaches that contribute to the capture, management, and collection of patient service revenue. Enhances a properly functioning revenue cycle process through a cross-department organizational structure.
Responsibilities:
Supports and manages the technical charge capture systems, processes and workflows of revenue generating departments for the organization to ensure timely and accurate recording of revenue, in accordance with all applicable governmental and institutional standards, bylaws, rules and regulations. Provides information to charge capture teams and operational directors/managers related to mechanisms of charge triggers, controls and reconciliation, and coding for purposes of compliant billing and charging procedures.Oversees Corporate Finance functions for State Medicaid Agency reporting (Florida Hospital Uniform Reporting System, Inpatient and Emergency Department/Ambulatory Surgery Quarterly Reports, Low Income Pool & Disproportionate Share Hospital reports) to ensure timely and accurate reporting.Supports department leaders in developing and implementing operational responses to new governmental regulatory requirements affecting charges, billing, payment and related issues as they relate to reimbursement. Includes assistance with financial pro forma models, explanation of relevant payment, coverage, licensure, enrollment, and other requirements for governmental reimbursement, and presentation of relevant alternatives.Develops strategies for improving payment from various governmental programs in compliance with all relevant rules and regulations. May include operational changes, creation of new payment models, tracking detailed data reporting, or other approaches to apply governmental payment rules to Memorial Healthcare System's (MHS) advantage.Participates in governmental relations activities relevant to Medicare, Medicaid and other reimbursement programs. Acts as a subject matter expert resource to Executive management and external advocacy firms for all things related to governmental payors.Oversees the MHS cost reporting and reimbursement team to ensure timely and accurate statutory reporting. This also includes Medicaid supplemental payment program reporting. Interim reporting, filed reports, audits, appeals, and reopenings are in this scope of responsibility.Plans and monitors staffing activities, including hiring, orienting, evaluating, disciplinary actions, and continuing education initiatives.Oversees the MHS 340B process to ensure compliant participation and optimal pharmacy discounts. Participates as a member of the 340B Oversight Committee. Supports the 340B team's efforts to expand access to pricing discounts. Considers 340B eligibility impact of cost report related strategies.
Competencies:
Education and Certification Requirements:
Bachelors (Required)
Additional Job Information:
Complexity of Work: Requires critical thinking skills, effective communication decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate timely action. Essential to have thorough knowledge of Medicare, Medicaid and Tricare/Champus rules and regulations, correct coding and billing instructions. Essential to have thorough knowledge of third party audit techniques. Proficient in Microsoft Office products and Cost Reporting Software. Required Work Experience: Ten (10) years of progressively responsible experience within reimbursement, hospital billing, coding, claims management or a related area required. Experience monitoring, accessing, and analyzing federal, state, and local laws and regulations. Experience with public speaking, including presenting educational sessions. Other Information: Additional Education Info: Bachelor's degree in Accounting, Finance, Business Administration, or in a job related field.
Working Conditions and Physical Requirements:
- Bending and Stooping = 40%
- Climbing = 0%
- Keyboard Entry = 60%
- Kneeling = 0%
- Lifting/Carrying Patients 35 Pounds or Greater = 0%
- Lifting or Carr
Source : Memorial Healthcare System