Director - Reimbursement - Acute

Director - Reimbursement - Acute

Join a dynamic organization driven by our passion for healthcare. UHS is seeking talented individuals who are eager to contribute their expertise and pursue rewarding careers. As a leader in acute care and behavioral health, UHS provides high-quality care to over 3 million patients annually, across our national network of facilities. The UHS Corporate Reimbursement Department is hiring a Director - Reimbursement - Acute to oversee Medicare–related payment activity that includes but is not limited to the reimbursement aspects of (1) Medicare alternate payment models (e.g. Bundled Payments) and (2) Quality Based payments such as Value-Based Purchasing, Hospital Acquired Conditions, Excess Readmissions and other quality based payment methodologies.

Key Responsibilities include:

• Complete Medicare and Medicaid cost report submissions for assigned hospitals or other UHS entities and related desk review and audit activity (including wage index reviews or other Medicare/Medicaid reimbursement activity) for multiple facilities with complex reimbursement environments and that have a high level of financial statement impact.
• Handle all cost report PRRB appeal activity, as applicable
• Provide independent on-going hospital reimbursement consulting services (e.g. compliance, billing, financial pro forma analysis) to UHS corporate business office, regional finance and to hospital executive staff and other UHS entities.
• Independently handles complex reimbursement projects and assignments
• Oversee, coordinate and develop the reimbursement aspects of all UHS acute care hospital Medicare alternate payment methodology activity with a focus on Bundled Payments.
• Oversee, coordinate and develops the reimbursement aspects of all UHS acute care hospital Medicare quality based payment methodology activity including but not limited to Value-Based Purchasing, Hospital Acquired Conditions, Excess Readmissions, etc.
• Participate in UHS acute care hospital SEC "Sources of Revenue" disclosure (10-k and 10-Q) activity related to the Medicare program (and Medicaid programs, as needed); as applicable
• Provide applicable Medicare and Medicaid contractual models, related reimbursement factors and other necessary data.
• Review these models for compliance and accuracy
• Assist VP-Reimbursement with the monitoring of Medicare and Medicaid legislative, regulatory and administrative rule activity.
• Assist with drafting of FAH public comment and provide estimated UHS financial impact, as directed by VP-Reimbursement
• Participates in the oversight, development and maintenance of Medicaid supplemental payment (SDP and UPL) and state Medicaid DSH programs for assigned facilities
• Oversee the completion of Medicare DSH packages for assigned acute care division hospitals and handles all related audit activity in coordination with the hospital's designated Reimbursement Manager, as applicable
• Oversee the completion of all Medicare DSH SSI ratio Cost Report Year End versus Federal Fiscal Year determinations and related activity, as applicable
• Oversee the completion of the Medicare cost report S-10 worksheet data elements using external software and handles related Medicare and/or Medicaid audit activity.
• Provide recommendation for changes in hospital charity and other financial assistance policy(s) (FAP's) to ensure compliance with the applicable federal and/or state rules and regulations and optimization of related reimbursement, as applicable

Qualifications

• Bachelor's degree with 10+ years' experience with expert knowledge of cost reporting applications and concepts.
• Comprehensive knowledge of Medicare prospective payment systems including Inpatient Acute DRGs, Outpatient APCs, Rehabilitation CMGs, Psychiatric DRGs, Skilled Nursing RUGs and Long Term Care LTAC DRGs
• Thorough understanding of Medicare statutes, regulations and administrative rules and their related legislative and regulatory processes
• Thorough understanding Medicare alternate payment concepts with a particular focus on Bundled Payments
• Thorough understanding of Quality based Medicare reimbursement concepts (i.e. Value-Based Purchasing, Hospital Acquired Conditions, Excess Readmissions, etc.)
• Expert knowledge of Medicare Disproportionate Share Hospital (DSH) rules and regulations
• Expert knowledge of Medicare S-10 Uncompensated Care (UC) rules and regulations
• Understanding of Medicaid supplemental payments (SDP and UPL), Health-care Related Taxes and Medicaid DSH payments
• Familiar with Medicare Provider Reimbursement Review Board (PRRB) Appeal Process
• Intermediate-to-Advanced level knowledge of Microsoft Excel
• Familiarity with Mckesson G/L and Siemens Invision
• Proficiency in HFS cost report software (or its equivalent)

This opportunity provides a rewarding career, challenging and rewarding work environment as well as growth and development opportunities within UHS and its subsidiaries, including competitive compensation, excellent Medical, Dental, Vision and Prescription Drug Plan, and 401k with company match.