Director of Reimbursement

Job Description

MINIMUM QUALIFICATIONS:

Education:

Bachelor's degree in Accounting, Finance or related field

Certification/Registration/Licensure:

CPA preferred

Experience:

10 years’ experience in healthcare, finance, or public accounting is preferred; as well as experience with third party reimbursement, cost reports, etc.

Experience in CAH/RHS reimbursement optimization, especially within an integrated health system is preferred

POSITION SUMMARY:

In this role, you will lead Bellin Gundersen Health System (BGHS) third party reimbursement.

ESSENTIAL JOB DUTIES/MAJOR RESPONSIBILITIES:

1. Oversee the monthly contractual allowance and reserve analysis for all third-party payers
2. Responsible for month end financial analysis of revenue, contractual allowances, and bad debt
3. Prepares estimated cost report settlements to support the month end close process
4. Reviews the costs report preparation and other information as required by federal and state laws, as well as other third-party contractors
5. Supports third party contract negotiations through detailed analysis, related costs and charges and access the impact of managed care contracts on reimbursement and contractual allowances
6. Maximizes reimbursement activities, wage index, especially as it relates to programs such as critical access hospital/rural health centers and other government programs
7. Responsible for the preparation of client prepared work papers and supporting documentation related to the year-end audit of contractual allowances, reserves, and settlements
8. Support external auditor requests
9. Develops the annual budget assumptions for contractual allowances, charity care and bad debt
10. Reviews and access financial impact of proposed and passed state and federal legislation
11. Assist in the preparation of the annual form 990, Schedule H
12. Acts as the liaison to fiscal intermediaries and other auditors regarding reimbursement matters
13. Develop and implement improvement opportunities for efficient third-party reimbursement function.
14. Direct and manage reimbursement team.
15. Leads, support and guides larger finance team (including CAH Finance Administrators) in reimbursement issues, special projects, and optimization efforts
16. Perform other duties as assigned.

Core for all Leaders
1. Organizational Strategy and Implementation -- Recognizes market trends, judges the impact on their AOR, contributes to responsive strategic plans, develops AOR operational plans, articulates these plans, and ensures they are communicated to gain alignment and commitment of all AOR staff.
2. Fiscal Management -- Effectively uses established processes to ensure accountability for effective operations and resource management.
3. Human Resource Management -- Effectively uses established processes to: select, align, develop, motivate, manage, and retain a team of highly skilled employees.
4. Excellence in Service and Quality-- Achieves seamless delivery of quality patient care, safety, excellence in patient experience, and customer service. Utilizes Continuous Quality Improvement principles and platform planning in decisions, improvements, and system design.
5. Organizational Leadership -- Provides leadership and accomplishes objectives by ensuring the integration of processes and initiatives while modeling collaboration. Participates and supports in brand/service delivery teams as requested.
6. Maintains accountability for implementation of requirements of regulatory agencies
7. Serves as liaison to the community
8. Duties and responsibilities as defined by specific department (if applicable)

PRACTICES AND PROMOTES BEHAVIOR CONSISTENT WITH THE MISSION, VISION AND VALUES:

Mission:

Together, we inspire your best life by relentlessly caring, learning and innovating.

Vision:

Leading with love, we courageously commit to a future of healthy people and thriving communities.

Values:

Belonging, Respect, Excellence, Accountability, Teamwork, Humility

Environmental Conditions

Not substantially exposed to adverse environmental conditions (as in typical office work)

Physical Requirement/Demands of the Position

Sitting - frequently

Static Standing - rarely

Walking/Standing - occasionally

Driving - occasionally

Reaching Below Shoulder - occasionally

Repetitive Actions Pinch Forces - occasionally Pounds of Force: 0-25

Repetitive Actions Fine Manipulation - frequently

Lifting – rarely Pounds of Force: 0-25

Job Type: Full-time

Ability to Commute:

• La Crosse, WI 54601 (Required)

Work Location: Hybrid remote in La Crosse, WI 54601