Director, Reimbursement and Decision Support

Location: Washington, DC
Date Posted: 06-05-2018
BASIC FUNCTION:
 
Under the direction of the Chief Financial Officer, the Director of Reimbursement and Decision Support is responsible for planning, organizing, staffing, directing, controlling and continually improving all aspects of HUH third party revenue reimbursement and analyses, for the accuracy of all clinical department revenue analyses, charging, charge master accuracy and completeness, charge entry, calculating departmental net revenue and maintaining an ongoing charge audit and rate setting.  This position is also responsible for analyzing managed care contracts, monitoring financial performance of contracts, analyzing department and division revenue cycle related data and reporting on trends and variances. The Director of Reimbursement and Decision Support is also responsible for all revenue budget, working with departments to make recommendations for revenue enhancements and preparing a cost benefit analysis for new revenue producing ventures for departments..
 
DIMENSIONS:
 
Reporting to this position are: Assistant Director of Revenue Integrity, Managed Care Operations Analyst; Senior Reimbursement Analyst; Staff Reimbursement Analysts; and Decision Support Analyst.
 
NATURE AND SCOPE:
 
Interacts internally with staff, executive management, department heads, patients and their families, and Hospital & University officials. Interacts externally with third party agencies, auditors, federal & local agencies, regulating agencies, vendors, consultants, and the general public.
 
PRINCIPAL ACCOUNTABILITIES:
 
Ensures that department results are consistent with the goals established by HUH to provide maximum financial success using best practice procedures
 
Captures, analyzes, audits, reconciles and reports all third party and Revenue opportunities.
 
Analyzes financial and statistical data used in reimbursement reports to determine accuracy, consistency from year to year, and effects upon the institution’s reimbursement or final settlements.
 
Calculates the contractual allowances for third parties and net revenue for the individual departments.
 
Prepares, verifies and analyzes final cost settlements submitted by third-party payers and governmental agencies for accuracy.
 
Provides assistance in response to inquires made by third-party auditors.
 
Prepares HUH revenue budget and recommends enhancement to revenue.
 
Works with Clinical documentation for review of HUH’s case mix index.
 
Assumes other duties and responsibilities that are related and appropriate to the position and area.  The above responsibilities are a general description of the level and nature of the work assigned to this classification and are not to be considered as all-inclusive.
 
ORGANIZATIONAL EXPECTATIONS:
 
Promotes adherence to the Health Sciences Compliance Program, the Howard University Code of Ethics and the Health Sciences Standards of Conduct.
 
Attends annual and periodic mandatory Compliance Program training including the Health Insurance Portability and Accountability Act (HIPAA) Privacy training.
 
Participates in activities that promote adherence to federal healthcare program requirements.
 
Actively participates in Health Sciences Compliance Program activities.
 
Adheres to the requirements of the HIPAA Privacy Policies and Procedures.
 
Maintains confidentiality of patients, families, and staff.
 
CORE COMPETENCIES:
 
Extensive professional knowledge of current health care trends, concepts, principles, theories, and practices.  
 
Knowledge and understanding of the third party regulations and compliance standards of other regulatory entities coupled with the ability to apply such to all the areas responsibility.
 
Ability to manage and negotiate contracts, charge master and revenue audit in a healthcare institution.
 
Ability to communicate effectively (orally and in writing) to operating officials and groups of employees, from numerous occupational fields and community organizations.
 
Competence in both oral and written English.
 
Ability to establish and maintain effective and harmonious work relationships with staff, physicians, Hospital and University officials, and the general public.
 
MINIMUM REQUIREMENTS:
 
Bachelors Degree in Business or related field.  Degree must be from an accredited university or college.
 
Five (5) years of budgeting or financial accounting experience.
 
Four (4) years of progressively management experience in a health care institution.
 
Must be able to stand, walk, sit, lift, write, type, speak, hear, see, write, calculate, compare, edit, evaluate and organize for extended periods of time
 
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