Reimbursement Director

JOB SUMMARY

 

The Director of Reimbursement is responsible for the timely and accurate reporting of net revenues derived from the participation in certain third-party programs.  Advises executive management with sound business/financial reimbursement advice concerning the billing, collection, reporting and optimization of revenues derived from services rendered to third-party program patients.

 

· Responsible for the preparation and filing of required Medicare and/or Medicaid cost reports in accordance with current governmental guidelines.  Reports should be files in a timely and accurate manner based upon the actual operations of the facility.  Additionally, all applicable and appropriate governmental regulations will be adhered to in determining the amount of reimbursement due from the program.  Defends the company’s position on cost report issues as they might arise during the audit of the report.  Identify and appeals issues that develop as a result of inappropriate audit adjustments.

· Develop and maintain a standardized charge description master for the entire company.  The master should ensure that all payors are billed in a manner which is consistent with all state and federal guidelines.

· Reviews computations of estimates of Medicare and/or Medicaid net revenues to be used for the accurate reporting of company financial statements.

· Properly records the financial impact of participation in the Medicare and Medicaid programs as first determined by the filing of the Medicare/Medicaid cost report and then finalized by the audit of that report.  Reconciles the difference between the monthly estimates and the as filed reports and/or audited reports and make appropriate adjustments to the monthly estimates.

· Reviews reimbursement/financial analysis of current operations and submit recommendation as to ways and methods to improve profitability.

· Provide reimbursement/financial analysis of new projects as requested. 

· Responsible for current knowledge of new regulations.  Provides overview and impact analysis to management on an as needed basis.

· Provides interpretation of current regulations and serves as the primary resource for questions related to reimbursement for third party payors.

· Seeks to increase cash flow through the submission of reports to obtain and update interium payments.  Aggressively pursue advantageous tentative settlements. 

· Regular attendance is required to perform the essential functions of this position.

· Employee must maintain performance levels that support the mission and philosophy of Intrepid USA of providing exceptional patient care and satisfaction.

· Employee must maintain confidentiality of patient and employee information at all times.

· The employee has attended compliance related in-services (evidenced by attending mandatory Corporate Compliance in-service, and /or Orientation, and/or mandatory quarterly inservices).

· The employee audits and monitors his or her departments for compliance issues.

· The employee creates an environment that encourages staff to report/resolve complicated issues.

 

 

REQUIRED SKILLS AND KNOWLEDGE

 

Education

Bachelor’s degree in Finance or Accounting or a related field required. Masters preferred.   

 

Prior Experience

Minimum of five (5) years experience at the senior management level.

Technical Expertise

· Knowledge of basic computerized word-processing, spreadsheet and e-communications required. Knowledge of home health billing and claims adjudication systems preferred.

· Familiarity with diagnosis, billing and reimbursement schemes such as ICD-9-CM, RBRVS, CPT, UB-92 and HCFA preferred.

 

Other Skills and Abilities

Excellent organizational, interpersonal, written and verbal communication skills.  Must be able to interact in a comfortable, intellectual, and professional fashion.

Supervisory skills are a must as the incumbent will have both “solid” and “dotted” line supervisory responsibilities. 

The individual must demonstrate the ability to maintain confidentiality.

Must also be able to demonstrate the ability to safely perform the essential functions of this position with or without reasonable accommodation.