Executive Director, Reimbursement
Job location: Miami, FL
Employment Type: Full-time
Posted data: 2021-02-05
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The individual will be responsible for monitoring changes in Federal and State regulations regarding hospital reimbursement requirements. Will function as the Hospital Division resident authority on these reimbursement issues and, as such, will be required to stay current on all the Medicare and Medicaid reimbursement regulations, manual provisions, and policy decisions. Responsible for staying current and monitoring changes in the AMA's CPT coding requirements for hospitals. Responsible for preparation and review of all Federal and State reports related to the hospitals' reimbursement.
Responsible for hospital's COM. Also responsible for setting up charge codes for new services and new departments.
Participates in strategic long-range planning
Monitors changes in Federal and States regulations effecting the healthcare industry
Prepares and administers education and training to clinical and administrative staff, as appropriate, for all significant changes to AMA coding requirements, Medicare/Medicaid Regulations, and State of Florida Laws affecting hospital reimbursement.
Coordinates system wide strategic pricing and sensitivity analysis Initiates and conduct management analysis studies
Responsible for preparation and review of the annual Medicare/Medicaid Cost Reports for all hospitals within UM system
Responsible for preparation and review of the annual State of Florida, Agency for Health Care Administration Reports
Responsible for preparation, analysis and review of all hospital COM changes.
Perform internal ongoing risk assessments and develop project plans to ensure implementation and compliance with federal and state guidelines.
Provide guidance and assist with performing root cause analysis and implementation of corrective actions
Identify overpayments and process adjustments, as necessary
Coordinate write-up of comment letters submitted to CMS pursuant to proposed rules
Evaluate internal risks and implement necessary changes associated with regulatory changes in COM and billing/coding policies and procedures. Ongoing coordination and implementation of regulatory changes across the COM, billing/coding, reimbursement, and revenue integrity functions
Structure, oversee and implement an internal audit process to ensure hospital facilities adhere to mandated regulatory changes.
Random sampling of claims.
Perform root cause analysis and Implement necessary corrective action plans.
Perform user acceptance testing of changes/action plans.
Disclose outcomes and corrective action plans to Finance management.
Trains, mentors, and supervises department staff to ensure compliance with applicable regulations.
Ensures internal control oversight and compliance with laws and regulations, safeguarding of assets, compliance with University policies and procedures, reliability of internal and external reporting, and efficiency and effectiveness of operations
Creates an effective control environment, conducts risk assessment, implements, and monitors controls. Oversees Hospital and UMMG A/R reserving/valuation
Tracking/Reporting and Compliance over CARES Act (HHS Provider Relief Funds) Leading implementation of RCA/Crowe which will provide automated capabilities over A/R valuation, payer analysis and performance Other duties as assigned
Bachelor’s degree in relevant field. Master’s preferred.
Certification and Licensing:
CPA certification preferred
Minimum 8 years of relevant experience.
Knowledge, Skills and Attitudes:
Knowledge of business and management principles.
Ability to direct, manage, implement, and evaluate department operations.
Ability to establish department goals, and objectives that support the strategic plan.
Ability to effectively plan, delegate and/or supervise the work of others.
Ability to lead, motivate, develop, and train others.
Strong written and oral communication skills
Able to work in a team environment
Able to work with minimal supervision
The University of Miami offers competitive salaries and a comprehensive benefits package including medical, dental, tuition remission and more.
UHealth-University of Miami Health System, South Florida's only university-based health system, provides leading-edge patient care powered by the ground breaking research and medical education at the Miller School of Medicine. As an academic medical center, we are proud to serve South Florida, Latin America and the Caribbean. Our physicians represent more than 100 specialties and sub-specialties, and have more than one million patient encounters each year. Our tradition of excellence has earned worldwide recognition for outstanding teaching, research and patient care. We're the challenge you've been looking for.
Patient safety is a top priority. As a result, during the Influenza ("the flu") season (September through April), the University Of Miami Miller School Of Medicine requires all employees who provide ongoing services to patients, work in a location (all Hospitals and clinics) where patient care is provided, or work in patient care or clinical care areas, to have an annual influenza vaccination. Failure to meet this requirement will result in rescinding or termination of employment.
The University of Miami is an Equal Opportunity Employer - Females/Minorities/Protected Veterans/Individuals with Disabilities are encouraged to apply. Applicants and employees are protected from discrimination based on certain categories protected by Federal law. Click here for additional information.Job Status:Full timeEmployee Type:StaffPay Grade:c110