Director, Reimbursement

Current Saint Francis Employees

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Full Time

Job Summary: Reporting to the Executive Director of Finance, the Director of Reimbursement is responsible for performing Medicare audits, cost reports, compliance, analysis and successful resolution of appeals for the health system. Additionally, the Director performs decision support analysis, pro-formas, and reimbursement impact analysis facilitating strategic reimbursement and operational decisions.

Minimum Education: Bachelor of Science Degree, required. Bachelor of Science in Business Administration with a Major in Accounting, preferred.

Licensure, Registration and/or Certification: Certified Public Accounting certification, preferred.

Work Experience: 3 - 5 years related experience.

Knowledge, Skills and Abilities: Working knowledge of Microsoft Word and Excel.

Effective interpersonal, written, and oral communication skills. Ability to perform and interpret automated word processing, database, and spreadsheet programs. Ability to organize and prioritize work in an effective and efficient manner.

Essential Functions and Responsibilities: Completes and reviews the annual Medicare cost report within the allotted time frame.

Directs and resolves issues pertaining to the audit findings as related to the annual Medicare cost report.

Prepares, analyzes, and provides supporting evidence necessary for successful resolution of cost report audits and appeals. This includes filing appropriate documentation and following regulatory protocol as it relates to appeals of the Medicare cost report.

Performs analysis, as requested, for project proposals, pro-formas and reimbursement impact. Takes initiative to conduct Medicare/Medicaid regulation research providing interpretation and financial impact to key leadership with recommendations for action. Monitors and manages compliance within applicable regulations, as it pertains to Medicare, cost reporting issues for all entities.

Coordinates and provides financial and patient utilization data to support outside financial audits. Supports 340B drug replacement plan for covered health system entities by providing appropriate patient and operational analysis to facilitate continued coverage status. Evaluates facility operational impact of key reimbursement changes and facilitates operational discussions to address and minimize negative impact.

Supports operational leaders and finance team in strategic analysis and pro-forma preparation by providing assistance and decision tools. Facilitates key leadership discussions to optimize governmental payor realization and strategic initiatives. Manage and mentor support staff for cost reporting and pro-forma completion providing value-add services to the health system.

Decision Making: The carrying out of non-routine procedures under constantly changing conditions, in conformance with general instructions from Senior leadership.

Working Relationships: Works with internal and external customers via telephone or face to face interaction.

Works with other healthcare professionals and staff. Works frequently with individuals at Director level or above.

Special Job Dimensions: None.

Supplemental Information: This document generally describes the essential functions of the job and the physical demands required to perform the job. This compilation of essential functions and physical demands is not all inclusive nor does it prohibit the assignment of additional duties.

Financial Services

• Yale Campus

Location:

Tulsa, Oklahoma 74136

EOE Protected Veterans/Disability