Vice President, Reimbursement and Revenue (Vanderbilt University Medical Center)
Vanderbilt University Medical Center is among the nation's premier institutions of academic medicine. Over the past 138 years, we've grown into a world-class enterprise. Our staff, faculty and students are driven to make a difference for people through education, discovery, innovation and patient care.
At a time when the financial aspects of health care are growing more complex and will remain in a state of rapid change, Vanderbilt offers an exciting leadership opportunity reporting to Associate Vice Chancellor for Finance at Vanderbilt University Medical Center (VUMC).
The Vice President - Reimbursement and Revenue will be responsible for the direction, preparation and coordination of government and commercial reimbursement programs across Vanderbilt University Medical Center (VUMC) with the dual goals of maximizing reimbursement within existing governmental and other payer regulations and guidelines and maximizing financial benefit to VUMC.
The ideal candidate will possess exceptional leadership skills in developing an integrated reimbursement and revenue strategy, implementing and executing key process improvements, and managing a diverse team of finance, revenue and reimbursement professionals.
The ideal candidate will partner closely with VUMC executives, financial and operational leadership teams and key executives in order to gather appropriate information to execute an integrated reimbursement and revenue strategy. The position will also direct the preparation and coordination of cost reports for VUMC and prepare the annual revenue budget and pricing strategy.
1. Supervise the preparation of cost reports for all VUMC entities and other required revenue-related reporting to any external entity ensuring adherence to all third party reporting requirements. Recommend appeals and re-openings for cost reports, as needed.
2. Conduct net patient service revenue accounting including the monthly preparation of balance sheet and income statement models for reserves and deduction entries at the entity level to support consolidation at the parent.
3. Develop appropriate reporting of such models and maintain and execute settlements estimates. Estimates include both technical and professional accounts receivable and revenue. Review the preparation and completion of analysis of accounts receivable and net revenue changes to support monthly close activities.
4. Interpret and estimate projected financial impact of changes in regulations on net patient service revenue. Coordinate with other areas of VUMC or VU Finance to complete additional revenue cycle analysis, as needed.
5. Conduct strategy analysis and planning for governmental and other regulatory reimbursement changes to minimize impact to VUMC.
6. Coordinate with VUMC and VU Finance to complete revenue related requests to support the annual external audit. Maintain comprehensive policies, procedures, and documentation to validate the existence and accuracy of all revenue related estimations.
7. Maintain and approve all line-item pricing for charge description masters with input from information technology and revenue cycle to optimize reimbursement from both governmental and non-governmental entities.
8. Develop annual gross and net revenue budget with input from Managed Care contracting, VUMC Finance and other impacted operational areas, as needed.
9. Develop an annual pricing strategy that seeks to maximize net patient services revenue within contractual or other constraints. Develop annual revenue deductions budget at the entity and product line levels.
10. Work collaboratively with teams across VUMC, VMG, and VHAN to communicate and educate leadership regarding revenue and reimbursement issues.
11. Coordinate with VUMC compliance to validate compliance with any governmental program that may impact reimbursement, including but not limited to effort reporting, 340B compliance, and recovery audit contractor (RAC) activity.
12. Hold the primary relationships with local governmental payer representatives. Maintain these relationships to favorably position VUMC within the local, regional, and national markets.
13. Direct contract management function (in coordination with Managed Care Contracting) to provide outside oversight and validation of the performance of various revenue cycle functions.
14. Supervise all reimbursement and revenue accounting staff.
Education: Work requires a Bachelor's degree in Accounting, Finance, Economics, Business or a related field. Master's degree in Business or Health Administration, Public Health and or CPA strongly preferred.
Experience: 8 years of reimbursement / revenue accounting experience with 3 - 5 years of consulting experience or health system experience at the Director level or above
Leadership and Staff Management Experience: Holds direct reports and division employees accountable for meeting or exceeding quality standards and goals, continues improvement toward excellence in revenue cycle generation, as well as balancing high patient satisfaction scores in areas impacted by the department.
Ability to be a self-starter who is intellectually curious, excited about "creating" in a fast-paced environment
Superior communication skills; expert at translating and communicating complex financial information to varying audiences
Ability to work in a highly-matrixed environment; receive direction from and build consensus with multiple sources
Hospital revenue and reimbursement experience in an academic medical center, including an in-depth knowledge of governmental and private payor payment methodologies strongly preferred.
Strong emotional intelligence - balance of wisdom and judgment with an ability to work independently with little direction
Extensive knowledge of governmental program guidelines, HCPCS, ICD, CPT's, Revenue Codes, DRG, payment methodologies, and managed care operations
Ability to compile data, analyze data, and make decisions that support department and VUMC objectives. Drives decision making process by performing detailed cost / benefit analysis, presenting and evaluating solution options, and driving consensus among key stakeholders
Subject matter expertise in areas of federal and state reimbursement models, regulatory filings and requirements, and experience with reimbursement strategies under government programs
Experience with compliance procedures and familiarity with leading an active compliance program to prevent fraud in the areas of revenue cycle
Demonstrated skill in navigating successfully through ambiguity and frequent change - agile and flexible as a leader, peer, coach and team member
Primary Location TN-Nashville-Crystal Terrace
Organization Department of Finance 108510PI75658147