PeaceHealth is seeking a System Director of Reimbursement for a 1.0 full time equivalent Exempt position.
Req ID: 165807
Directs, controls and is accountable for Reimbursement across the PeaceHealth system under the leadership of the System VP Financial Integrity. Develops long- and short-term business strategies, operational plans and oversees implementation. Manages the design, structure, development and planning issues within scope of direction. Responsible for all aspects of third party government payer reimbursement functions for the health system. This includes Medicare, Medicaid, and other Governmental Cost Report filings/audits/appeals, State provider tax programs, and staying current on all Federal and State government regulatory payment changes. Ensures the reimbursement team is proactive in identifying new opportunities, projecting impacts of various proposals impacting reimbursement, and effectively communicating these activities with the finance leadership throughout the system.
1. Directs third party government payer reimbursement functions for the health system. Manages the following as they relate to Cost Report and Regulatory Reporting: files Medicare and Medicaid cost reports for large PPS hospital and multiple Critical Access Hospitals; coordinates all Medicare audits; files Medicare appeals and follow-up as necessary; verifies Medicaid days used for Medicare disproportionate share calculation; performs annul resolution of wage index data issues; intern and resident counts for medical education programs, researches and interprets Medicare/Medicaid regulations as requested from various stakeholders; and calculates third part reserves at year-end with periodic interim reviews as needed.
2. Proactively identifying reimbursement issues to protest, appeal and protect the System's rights related to the reimbursement to be determined in future periods.
3. Performs evaluation of impact of proposed and final Medicare and Medicaid reimbursement changes, including but not limited to inpatient DRG, outpatient APC, Inpatient Psychiatric PPS and Inpatient Rehabilitation PPS.
5. Continually identifies reimbursement opportunities which may include rural health providers, exempt units, home office cost reports, etc.
6. Reports the financial impact of current, future and expected reimbursement of each business unit. Forecasts reimbursement for the Long Range Financial Plan and annual operating budget for all payors.
7. Generates customized reimbursement analyses and or reports as needed on proposed new operational projects, governmental reimbursement programs (e.g. Medicare, Medicaid, etc.) or changes in state or Medicare reimbursement or funding, or other reimbursement related analyses that will assist management to enhance operational decisions.
8. Oversees monthly calculation of accounts receivable reserves including contractual adjustments, cost report settlements, bad debt and charity.
9. Oversees the calculation and establishing of contractual reserves for all health plans and third party liabilities for the financial statements.
10. Reviews and prepares the uncompensated costs for charity, Medicaid, Medicare and other government programs supporting community benefit reporting.
11. Provides system-wide leadership, direction and management to geographically dispersed reimbursement staff.
12. Other duties as assigned.
Bachelor's in Business Administration, Finance/Accounting required or a combination of education and experience that provides the caregiver with the requisite knowledge, skills and abilities to perform the job.
Master's degree preferred.
Minimum of 10 years experience in healthcare, specifically hospital reimbursement is required.
Minimum of 5 years of management experience required.
Certified Public Accountant (CPA) preferred.
Ability to deliver financial results for areas of accountability.
Solid process improvement skills.
Excellent verbal, written, and presentation skills.
Excellent interpersonal skills and ability to connect with all levels within the organization and external vendors.
Strong analytical and negotiating skills.
Strong skills in mediation, conflict resolution and investigations.
Ability to develop and present concise information.
Knowledge of third-party reimbursement rules, regulations and procedures.
Ability to think critically; work efficiently and responsibly in a collaborative environment with multiple work demands and short time frames.
Ability to communicate effectively verbally and in writing; be flexible; initiate and lead change
Must demonstrate leadership ability.
Strong communication skills, both verbal and written.
Excellent computer skills including proficiency with MS Office applications.
Please apply online to be considered. For full consideration of your skills and abilities, please attach a current resume with your application.
PeaceHealth, based in Vancouver, Wash., is a not-for-profit Catholic health system offering care to communities in Washington, Oregon, and Alaska. PeaceHealth has approximately 16,000 caregivers, a multi-specialty medical group practice with more than 900 providers and 10 medical centers serving both urban and rural communities throughout the Northwest. In 1890, the Sisters of St. Joseph of Peace founded what has become PeaceHealth. Today, PeaceHealth is the legacy of its founding Sisters and continues with a spirit of respect, stewardship, collaboration and social justice in fulfilling its Mission.
We offer competitive compensation, a robust benefits package and a collaborative, Mission-driven work environment! To learn more about working at PeaceHealth and the Vancouver community please visit our homepage: www.peacehealth.org/careers .
Location: Vancouver , Shared Services Center (802) Job Category: Leadership FTE: 1.0 Work Type: Full Time Required Certifications/Licensure:
PeaceHealth is committed to providing equal employment opportunities to all qualified job applicants and employees without regard to the following statuses: protected veteran; qualified individual with a disability; race; ethnicity; religion; gender; pregnancy; gender identity; national origin; age; genetic information; sexual orientation; or any other protected status in accordance with local, state, or federal laws.
The above information is intended to indicate the general nature and level of work performed by this position. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of caregivers assigned to this job.
Posting Notes: Vancouver || Leadership || Business, Administrative, & Facilities Leadership || Full Time || FINANCE SVCS
Internal Number: 165807
PeaceHealth Physicians are as diverse as the communities they serve, but have the following in common:Dedication to carrying on the healing mission of Jesus Christ by promoting personal and community health, relieving pain and suffering and treating each person in a loving and caring way.A shared vision of every patient receiving exceptional, compassionate evidence-based care, every time, every touch.