Director of Finance Government Reimbursement - Government Reimbursement

Minimum Qualifications:

Bachelor's degree in accounting, business, or related field. and ten (10) years Medicare and Medicaid reimbursement experience, with at least six years of reimbursement experience at manager level or above.

Preferred Qualifications:

• Master's degree in accounting or business and/or a CPA.
• Experience with Medicare IME, DGME, DSH and Organ Acquisition reimbursement and experience with Texas Medicaid and state supplemental payment methods.

Job Summary:

Plan, design, implement, and maintain an effective and efficient program to ensure that UTMB receives appropriate government payor reimbursement and complies with Medicare and Medicaid cost reporting regulations.

Scope: Institutional

Job Duties:

• Supports and assists AVP, Finance-Government Reimbursement in developing reimbursement strategies, ensuring compliance, and providing direction to Government Reimbursement staff.
• Supports and assists AVP, Finance-Government Reimbursement in providing analyses, advice, and direction to senior management, staff, and other departments related to changing regulatory reimbursement requirements and related to appropriate compliance with Medicare and Medicaid statutory and regulatory requirements.
• Supports UTMB Legislative Affairs department with various state reimbursement strategies, analyses and state agency interactions.
• Leads state supplemental reimbursement analyses and provides input and support for state-directed payment program participation and analyses.
• Leads and directs preparation of annual Medicare, Medicaid, and TDCJ net revenue budget rates.
• Provides oversight, direction, and analyses of Medicare and Medicaid reimbursement including, but not limited to, cost report preparation, audits, tentative settlements, reopenings, appeals, IME, DGME, DSH, UC, Organ Acquisition, Bad Debt, Wage Index, Physician Time Studies, Paramedical Education Time studies and Provider Enrollment.
• Provides oversight and direction on external audits, including but not limited to Medicare, Medicaid, state, and OIG.
• Provides oversight of monthly Medicare and Medicaid settlement account estimates, related analyses, and third-party audits.
• Provides oversight of quarterly reimbursement estimates and annual cost reports provided to UTMB-CMC staff related to TDCJ patient services.
• Represents the Government Reimbursement department on various committees and task force groups.
• Maintains current knowledge of Medicare reimbursement and cost reporting regulations, keeping abreast of recent changes that may affect the department’s policies and procedures, and takes necessary actions to implement appropriate processes and procedures to ensure compliance with Medicare and Medicaid regulations.
• Develops and implements new policies, procedures, and standards, implements appropriate internal controls for the department, and provides mechanisms to monitor and enforce compliance.
• Assumes lead role in planning, preparing, and monitoring departmental budget.
• Leads recruitment, hiring, orientation, training, supervision, evaluation, disciplinary action, and/or termination process, as needed, within department.
• Adheres to internal controls and reporting structure.
• Performs related duties as required.

Knowledge/Skills/Abilities:

• Knowledge and understanding of Medicare and Medicaid reimbursement regulations.
• Knowledge of State/Medicaid supplemental payment programs and issues.
• Knowledge of generally accepted accounting principles, cost accounting, and government accounting.
• Knowledge of UTMB’s patient accounting, financial, business, and administrative systems.
• Ability to perform complex accounting functions requiring specialized knowledge of Medicare and Medicaid.
• Ability to execute the efficient retrieval, compilation and utilization of financial data and statistical information for maximum and appropriate reimbursement from Medicare and Medicaid.
• Ability to analyze/evaluate data and make appropriate decisions/recommendations.
• Strong oral and written communication skills and ability to communicate with all levels of the institution.
• Ability to plan, develop, organize, and accomplish goals.
• Ability to organize and manage multiple projects simultaneously.

Decision-Making Responsibility:

Broad decision-making responsibility related to the implementation of government reimbursement regulatory changes, oversight of government payor settlement estimates, and providing direction in preparation of the Medicare, Medicaid, and TDCJ cost reports in compliance with government laws and regulations.

Salary Range:

Actual salary commensurate with experience.

Work Schedule:

Hybrid (in-office/remote) role as determined by leadership.