Reimbursement Services Director directs and supervises the activities of the claims and provider reimbursement personnel. Handles third-party reimbursement for services rendered to patients. Being a Reimbursement Services Director sets procedures for filing reimbursement claims and ensures timely and accurate claims payments. Monitors, evaluates and reviews all cost reporting in support of reimbursement claims. Additionally, Reimbursement Services Director develops policies and procedures compliant with fiscal and regulatory requirements. Oversees the collection of statistical and financial data needed for preparing annual and monthly health insurance reports. May require an advanced degree. Typically reports to top management. The Reimbursement Services Director typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. To be a Reimbursement Services Director typically requires 3+ years of managerial experience. (Copyright 2024 Salary.com)
Supports the Vice President, Reimbursement in all matters related to third-party accounting within the AAH service area. In addition, this position is to serve as a key liaison between the Reimbursement department and hospital financial leadership as well as governmental auditors and will be looked to as a departmental leader in technical issues related to the monthly financial close. Monitors proposed and final government reimbursement regulations and provides oversight in the development of the financial analysis around government and commercial reimbursement to determine the overall impact the changes have on the organization. Proposes changes to strategies to address the changes in reimbursement in order to maximize AAH’s reimbursement.
Scheduled Hours
Corporate business hours. This position is primarily remote; willing to consider out of state candidates.
Licenses & Certifications
None Required.
Degrees
Bachelor's Degree in Accounting, or
Bachelor's Degree in Finance or related field.
Required Functional Experience
Typically requires 7 years of experience in health care reimbursement or public accounting with a concentration in hospital auditing that includes extensive auditing of the hospital net patient service revenue area, Medicare, Medicaid, or Blue Cross.
Required Management Experience
Includes 3 years of management experience in managing staff and budgets.
Knowledge, Skills & Abilities
Ability to use Microsoft Office programs. Ability to use Medicare/Medicaid cost reporting software. Ability to use AAH’s general ledger, accounts payable, payroll, patient accounting, and decision support systems. Must possess strong analytical and accounting skills. Must possess detailed knowledge of various reimbursement methodologies such as DRG, per-diem, capitation and percent of charges. Must possess detailed knowledge of Medicare and Medicaid reimbursement rules as well as a detailed understanding of the Illinois Blue Cross UPP system and Graduate Medical Education, Disproportionate Care, Transplant programs, and 340B issues. Must possess the ability to work independently and under stressful conditions. Must be able to work weekends during peak cost reporting times, budget season and during year-end audit. Must possess strong communication and interpersonal skills and the ability to communicate revenue cycle issues to all levels of the organization.