Regional Director, CAH Reimbursement-Remote

Trinity Health; United States; Remote; USD 120,000 - 180,000; Full time

Job summary

A leading health organization seeks a Regional Director of Reimbursement responsible for managing financial functions and compliance risks across multiple facilities. This role requires extensive experience in healthcare reimbursement and the ability to mentor staff, ensuring effective communication and strategic planning for revenue management.

Qualifications

• Over ten years of experience in health care reimbursement management.
• Experience with CMS Fiscal Intermediaries for audits.
• Ability to lead change and standardization within processes.

Responsibilities

• Serve as primary contact for Regional CFO and ensure net revenue tracking.
• Manage all financial and compliance risks associated with reimbursement.
• Direct year-end audit preparation for reimbursement issues.

Skills

Rural/CAH reimbursement experience

Financial statement interpretation

Analytical skills

Interpersonal skills

Customer service orientation

Education

Bachelor’s degree in business administration, Accounting or Finance

Master’s degree (preferred)

Certified Public Accountant (CPA) preferred

Job description

Employment Type: Full timeShift: Description: POSITION PURPOSE

The Regional Director of Reimbursement serves as the primary contact to the Regional Chief Financial Officer along with the Regional Health Ministry (RHM) Vice Presidents of Finance and the Regional Ambulatory Services Leadership to provide them with an understanding of their business, net revenue estimates, balance sheet valuations, net revenue budgets, mid-month projections and regulatory changes. The role provides critical help to the Vice Presidents of Finance in understanding their business so appropriate and timely decisions can be made. The incumbent provides leadership to a Regional Shared Service Center managing the reimbursement function for up to ten Trinity Health RHMs (with net revenues of $2 billion annually). The position is responsible for managing and mentoring all Shared Service Center managers and staff and is also required to manage the relationships between the Shared Service Center and RHM Vice Presidents of Finance.

This position identifies and manages all financial and compliance risk associated with the reimbursement function, keeping senior leadership apprised of identified risk and tracks progress with risk management plans. It works closely with and supports other revenue functional areas including payer negotiations and contracting, patient financial services, utilization management and coding. It serves in an advisor capacity to RHMs in region and to the Reimbursement and Revenue Integrity Central Operations Team. The role identifies and implements leading practices, processes and technology necessary to achieve objectives and engage key stakeholders by leading effective change management. Responsible for leading and participating in initiatives to improve net revenues, reduce receivables and improve compliance associated with the Southeast Michigan professional (ambulatory) services.

ESSENTIAL FUNCTIONS

• Knows, understands, incorporates and demonstrates the Trinity Health Mission, Vision and Values in leadership behaviors, practices and decisions.

• Prepares the department budget and manages use of resources within budget targets.

• Responsible for hiring, retaining, evaluating, mentoring and firing managers and staff within the department.

• Responsible for managing all financial and compliance risk associated with the reimbursement function (for acute and professional services), notifying senior leadership of identified risks and tracking and monitoring progress of risk management plans.

• Directs the preparation of RHM net revenue calculations and reviews with the Vice Presidents of Finance prior to financial statement due date. Directs the preparation of the budgeted net revenue calculation for the RHMs.

• Manage the overall balance sheet position related to third party contractuals and related reserves. Provide updates to Senior Leadership to avoid any surprises.

• Directs the preparation of RHM cost reports and other third-party filings. Directs the preparation for third party audits and takes a lead role in resolving audit issues and developing appeals. Directs the preparation of reports, position papers, impact analysis and development of recommendations concerning specific reimbursement issues. Participates in developing group appeals for all Trinity Health concerning reimbursement disputes with third party payors.

• Develops strategic reimbursement planning and analysis for short and long-term operating plans and capital projects (for acute and professional activities).

• Provides financial planning assistance to Regional Chief Financial Officer and RHM Vice Presidents of Finance and Ambulatory leadership relative to current reimbursement practices and proposed changes in both the public and private sectors and provides the Leadership with the latest updates on changes in reimbursement regulations. Provides direction in the development of reimbursement strategies that reflect changes in the reimbursement environment.

• Develops and implements policies and procedures to ensure reimbursement procedures, practices and reporting adhere to compliance regulations.

• Directs reporting process and reconciliation of general ledger accounting for third party payments and settlements, including third party payor receivables, payables and reserves. Responsible for matters which include areas of policy development and ongoing reporting.

• Provides education and consultation to staff to ensure accuracy of third party reporting. Maintains expertise in reimbursement strategies through appropriate educational and organization activities.

• Directs year end audit preparation for reimbursement issues ensuring the continued integrity of financial records through the design and implementation of appropriate controls.

• Participates in RHM management and staff meetings to provide reimbursement support.

• Represents RHMs when reporting to and dealing with external agencies such as the Centers for Medicare and Medicaid Services (CMS), third party payors, federal regulatory agencies and other health care entities regarding reimbursement practices, policies and regulations.

• Promotes change in public and private sector policies and procedures in order to optimize the performance of RHMs while maintaining consistency with the Trinity Health mission and values. Involvement in various association task forces that develop policy recommendations, such as the Michigan Hospital Association.

• Participates in the negotiation, implementation and ongoing review and monitoring of contracts with third party payors and managed care entities.

• Maintains functional accountability to the Trinity Health Vice President of Reimbursement to ensure accurate and timely reporting, consistency of methodology, adherence to compliance programs and sharing of best practices across Trinity Health.

• Maintains a working knowledge of applicable Federal, State and local laws/regulations; the Trinity Health Integrity and Compliance Program and Code of Conduct; as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.

MINIMUM QUALIFICATIONS

Must Haves for this position:

• Must have Rural/CAH reimbursement experience

• Cost report preparation and strategy specific to CAH and RHCs

• Experience in leading change and standardization

• Experience in working with CMS Fiscal Intermediaries for audits and other payor analysis

• Experience in month end and GL reporting of net patient revenue / analyzing financial results

• Bachelor’s degree in business administration, Accounting or Finance or an equivalent combination of education and experience. Master’s degree is preferred.

• Certification as a Certified Public Accountant (CPA) preferred.

• Over ten (10) years of progressively more responsible experience in health care reimbursement management. Experience managing multiple facilities preferred.

• Ability to develop and interpret financial statements and reports.

• Working knowledge of generally accepted accounting principles and a thorough understanding of third-party reimbursement mechanisms and contracting strategies.

• Ability to communicate in clear, concise terms with management and governance at all levels, including communication with C-Suite executives.

• Ability to work effectively in a matrix organizational structure and influence others.

• Well-developed conceptual and analytical skills.

• High level of interpersonal, management and organizational skills are necessary with special focus on customer service orientation skills.

• Must be able to operate effectively in a collaborative, shared leadership environment.

• Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.