Reimbursement Director

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Reimbursement Director
Duties: Manage the government reimbursement personnel for the corporation, and it reports to the Reimbursement Senior Director. Assists in the direction of the following areas for government payers for the Corporation: interim and final payment processes, general ledger accounting, rolling forecasts, and analysis. Provides central direction and education for the technical and operational aspects of the government reimbursement area and helps ensure the technical accuracy and proper functioning of all government payer systems and operational processes. Monitors new payment-related legislation and regulations and advises Central Office and Hospital management of its implications for all government reimbursement areas including contractual allowance calculations, feasibility studies, cost reports, and financial forecasts. Interacts with the internal and external auditors and assists in lobbying efforts to ensure that interests are represented. Interact with various government agencies, including national, regional and state level Medicare agencies and Medicare administrative contractors, national and state (Idaho and Utah) Medicaid agencies, TRICARE agencies, and state hospital associations. Identifies material regulatory or statutory changes to include in Medicare and Medicaid contractual allowance calculations to have technically acceptable and reasonably conservative reimbursement methodologies. Helps develop and review the calculation templates or other reporting output to determine the impacts of the regulatory or statutory changes are appropriately applied. Reviews government payment calculations, government payer general ledger reconciliations, claims monitoring logs, and systems managed by the Reimbursement Director’s direct reports as well as those for assigned Intermountain facilities. Communicates with Revenue Cycle, Accounting, Information Systems, Internal Audit, and the External Auditors to ensure that all operational systems are appropriate and functioning. Helps determine financial forecast assumptions for the rolling forecasts and the 5-year plan for Medicare and Medicaid reimbursement. Reviews the appropriateness of the assumption calculations in the software for rolling forecasts and 5-year plans. Provides prospectus assumption information for long-term debt (i.e., bond) financing, interprets current law, and anticipates future trends and legislation. Responsible for the central development and review of spreadsheet applications and software and reimbursement methodologies for Medicare and Medicaid cost report work papers, surveys, and other government reporting. Responsible for Central Office cost report preparation and/or review and for the review of assigned facility cost reports. Negotiates with government agencies on behalf of the hospitals in resolving interim and final payment disputes. Works with internal and external legal counsel and Compliance to resolve disputes in the governmental appeal and legal processes. Monitors new payment-related legislation and regulations for the government reimbursement area and directs the preparation of analyses and the provision of recommendations to Central Office and Hospital management of service changes and/or rate adjustment requests which would enhance reimbursement and/or make operations more efficient. Responsible for other duties as assigned, such as the review of Medicare Advantage and Medicaid managed care contracts negotiated by Payer Contracting.

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