SS Manager, Reimbursement Clinical Economics
- Full Time
Responsibilities and Tasks The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified. 1. Manages and directs the operations of the Reimbursement and Revenue Advisory Services department including employee work scheduling, staffing and other personnel activities; applies UMMS policies and procedures as well as federal, state (HSCRC), and local statues or regulations governing reimbursement to insure accurate and effective service. A. Ensures that UMMS policies and procedures are interpreted and applied correctly. Develops and implements reimbursement policies and procedures as necessary to improve department operations. Provides technical support regarding the implementation of HSCRC reimbursement methodologies and revenue reporting requirements to the VP, Directors, and Senior Managers of Finance Shared Services, to CFOs of member hospitals and to other members of Senior Management. B. Supervises the preparation of the monthly financial statement revenue in accordance with UMMS procedures and HSCRC defined methodologies. C. Reviews monthly HSCRC volume and revenue submissions; communicates with the HSCRC as necessary. D. Ensures the accurate and timely preparation of various HSCRC, Medicare and other regulatory reports on a monthly, quarterly and annual basis. Manages the staff during the Annual Filing and Medicare Cost Report preparation processes. E. Coordinates annual external HSCRC and other regulatory audits and ensures that all information is available and completed on a timely basis. F. Maintains and disseminates monthly revenue reports to UMMS Finance Shared Services and hospital CFOs. 2. Manages the reporting and monitoring of key Reimbursement functions which includes: A. Development, implementation and monitoring of reimbursement strategies to maximize revenue and monitor price position in marketplace. B. Management of monthly rate analytics and the adjustment of rates to ensure compliance with federal, state (HSCRC) and local laws and regulations and oversees the preparation of the annual approved rate calculation and rate reviews for various UMMS hospitals. C. Responsible for the detailed preparation of the HSCRC Annual Filing and other regulatory disclosures, assisting with the detailed preparation of the annual Medicare Cost Report and completion of the annual Revenue Budget. 3. Manages and directs a staff of Senior and Reimbursement Analysts in accordance with departmental and UMMS personnel policies and procedures. A. Performs individual performance evaluations and recommends and/or initiates corrective actions, as needed. Establishes clear and concise work procedures and expectations, assessing performance levels by monitoring results and providing positive and constructive feedback. B. Ensures timely and accurate completion of work by monitoring daily work activities. C. Trains staff on new accounting practices, provides guidance on technical and reporting issues and otherwise promotes staff professional development. 4. Communicates regularly with decision support, financial reporting and other finance personnel to ensure optimal efficiency and effectiveness of financial reporting. 5. Keeps abreast of current regulatory (federal, state, HSCRC and JCAHO) information/guidelines and new, related hospital policies; communicates relevant changes and/or protocol and procedural revisions to staff. Implements appropriate department operational changes to ensure compliance. 6. Attends and participates in in-service training and various educational programs for professional growth and development. 7. Keeps up-to-date on changes in the hospital finance and reimbursement field.