PRIMARY FUNCTION(S):

Under the direction of the Director, Decision Support and Reimbursement, this position leads the reimbursement and cost reporting functions of ChristianaCare. Oversite of these functions, and the management of the departmental staff supporting these functions, will ensure that reimbursement systems are maintained in a manner to comply with regulatory standards and evaluated to preserve the organizational vitality goals of ChristianaCare.

PRIMARY DUTIES AND RESPONSIBILITIES:

• Manages the staff, processes, and procedures necessary to evaluate, maintain and submit Medicare cost reports, third-party reimbursements, and other reports and questionnaires that are consistent with organizational goals and expectations.
• Manages the staff, processes, and procedures necessary to evaluate, maintain, and submit HSCRC reporting on a month, quarterly, and annual basis.
• Manages the staff, processes, and procedures to ensure HSCRC rates are properly evaluated and set in a manner to comply with HSCRC regulations.
• Responsible for the positive resolution of third-party audits and inquiries through management of reimbursement staff, direct communication with third-party representatives, and keeping Finance Leadership informed on a timely basis.
• Manages the analysis of regulatory changes and communicates the impact to Finance Leadership.
• Collaborates with internal and external department staff to address regulatory impacts.
• Under the direction of Departmental Leadership, provides education to system leadership and staff on regulatory changes and reimbursement impacts from all third-party payors.
• Responsible for the compliance of 340B regulations and keeping Finance Leadership informed on a timely basis.
• Provides for the calculation and the report of reimbursement rates to be utilized in third-party reserves, financial forecasts, and annual budgets.
• Responsible for the timely and accurate maintenance of third-party contract modeling.
• Collaborates with Managed Care Contracting staff to ensure third-party reimbursement model assumptions are updated timely and accurately to support the evaluation of payment options.
• Collaborates with Managed Care Contracting staff and external vendors to maintain contract modeling software.
• Collaborates with Departmental Leadership and staff to support the development and evaluate the impact of alternative payment models.
• Provides education to system leadership and staff with to support the organizational vitality goals outlined by Departmental Leadership.
• Ensures staff embodies the ChristianaCare Way: Serve with Excellence and Love.
• Promotes and encourages the core values and teamwork to enhance departmental service to the organization.
• Ensures adequate staff education and training; evaluate staff performance, identify areas for performance improvement and provide positive coaching if necessary.
• Other duties assigned.

DIRECTION/SUPERVISION OF OTHERS :

Reimbursement Analyst, Senior Reimbursement Analyst(s).

EDUCATION AND EXPERIENCE REQUIREMENTS :

BS/BA in Accounting or Finance required; MS/MBA preferred.

Active professional certification of financial relevance desirable.

At least six years of experience in a major acute care teaching hospital setting or equivalent.

KNOWLEDGE, SKILLS AND ABILITIES REQUIREMENTS :

Working knowledge of principles of Medicare and Medicaid Reimbursement

Working knowledge of HSCRC and other Maryland Reimbursement requirements is a plus

Preparation and analyses of departmental, service and organization financial proformas

Strong analytical, communication and presentation skills

Knowledge of Microsoft Excel and Office Required

Working knowledge of Compu-Max Medicare Cost Report software or similar is a plus

Working knowledge of Medicare Medical Education impacts and requirements is a plus

Working knowledge of Workday Financials and Planning is a plus

Self-starter requiring limited supervision

Knowledge of department policies, procedures, and operations

Ability to maintain confidential information and materials

Ability to establish and maintain positive working relationships

Ability to exercise judgment, tact, and diplomacy