Regulatory Reimbursement Coordinator

To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.

Responsible for the coordination of the hospital reimbursement function, analytic, technical, regulatory and information systems support. Coordinates the annual Medicare cost report preparation, supporting documentation , filings and audits. Facilitates the successful resolution of cost report appeals and settlements and maintains good relationships with outside auditors. Leads multi-disciplinary work groups on projects associated with Reimbursement. Serves as technical advisor on reimbursement matters to staff, Hospital and System leadership. Participates in monthly and annual financial analysis related to net revenue and accounts receivable generated through the regulatory reimbursement. Coordinates the work of others on numerous, simultaneous projects including wage index and Medicare Disproportionate Share. Works to assure the accuracy and accountability of reported reimbursement information to the public and governmental agencies. Supports special audits as required . Supports and enhances the compliance effort of the Hospitals and the System. Stays current with regulatory guidelines and changes while educating the reimbursement team. EEO/AA/Disability/Veteran.

EEO/AA/Disability/Veteran

Coordinates all projects and staff associated with the Reimbursement function, including annual Medicare cost report preparation, maintenance of accurate and comprehensive supporting information, timely, accurate and compliant filings, analysis and audit support.

Maintains advanced knowledge on reimbursement rules, regulations, and policy. Serves as technical advisor on reimbursement issues. Stays abreast of routine developments in Reimbursement.

Coordinates the challenge to and appeal of Medicare cost report findings for successful resolution. Drafts alternatives or options for consideration by management, recommends best technical strategy and approach . Drafts appeal documents and position papers. At times, negotiates with auditors to remove or challenge findings or appeal issues.

Coordinates the monthly and annual net revenue computations, valuation, projects and staff associated with same. Includes coordinating budget assumptions, maintaining detailed back up schedules, financial analysis , assuring the accuracy of accounting entries.

Coordinates the Third-Party schedule supporting the Hospital's balance sheet through issue identification, supporting workpapers and computations, supporting the needed accounting entries.

Coordinates a monthly Reimbursement project inventory and workplan, including project description, timeframes, future planning requirements and staffing recommendations.

Coordinates efforts of multi-disciplinary groups responsible for projects involved in the management and enhancement of Reimbursement, as required. At times, will be expected to lead these groups.

Assists with financial analysis associated with residency programs to support the clinical teams work in growing the residency programs.

Works to assure accuracy and accountability of Reimbursement information reported to external auditors , governmental agencies and the public in addition to underlying information systems related to reimbursement

Analyzes Medicare final rules to capture relevant changes for the System. Calculates the financial impact of new wage index along with Market basket increases.

Participates in guidance to and support of administrative or clinical departmental needs on questions , process, status changes or updates to Reimbursement requirements, protocols and regulations.

Researches and resolves Reimbursement questions or issues.

Performs other duties as required.

EDUCATION (number of years and type required to perform the position duties):

B.A. or B.S. in Accounting, Finance, Healthcare Administration, Mathematics, Information Systems or similar field required.

EXPERIENCE (number of years and type required to meet an acceptable level of performance):

Five or more years of experience in health care finance, reimbursement, public or other accounting, auditing, budget, compliance, with progressive responsibility in leading projects, coordinating staff assignments and monitoring the completion of work.

SPECIAL SKILLS:

Significant knowledge of Medicare regulatory reimbursement rules, regulations and accounting and auditing theory is assumed. Assumes working knowledge in the field of health care, including experience with revenue cycle functions hospital billing. Demonstrated ability to lead groups and work on numerous projects simultaneously. Assumes some knowledge of decision support theory and concepts, experience with databases, data manipulation and familiarity through prior use, of Microsoft office products. Ability to influence and direct the thinking of others and interact with all levels of management and staff.

ACCOUNTABILITY (how this position is held accountable for such as goals achievement, budget adherence, or other areas of accountability):

Responsible for the coordination of reimbursement projects and Medicare cost report filings for the Health System . This function contributes directly to annual revenue performance through maintaining accurate third -party reserve data and detailed supporting documentation. The coordinator is accountable to ensure all deadlines for Medicare cost report submissions and other regulatory reporting is submitted with the highest degree of accuracy and is on time. Work is required to be done in a fashion that is compliant with Medicare and other payors' standards and regulations. Assures the success of numerous projects by offering technical advice and coordination for reimbursement opportunities. Investigates problems and makes recommendations to management for future projects related to reimbursement. Coordinates the project workplan for reimbursement efforts. Offers feedback to Sr . Manager for staff performance evaluations.

In personal and job-related decisions and actions, consistently demonstrates the values of integrity (doing the right thing), patient-centered (putting patients and families first), respect (valuing all people and embracing all differences), accountability (being responsible and taking action), and compassion (being empathetic).

COMPLEXITY (describe planning, problem solving, decision making, creative activity, or other special factors inherent in the responsibilities of this position):

Serves as a knowledgeable and experienced resource on reimbursement issues related to cost reporting, revenue, Medicare and Medicaid payment rules and regulations for the Hospital and coordinates efforts with System management. Coordinates multi-disciplinary efforts for reimbursement projects and cost reporting support and development. Exercises independent judgment and discretion in the performance of reimbursement duties. Coordinates assigned project priorities, staffing assignments and financial valuations of opportunities. Acts as a resource and coordinator for the reimbursement matters at the Hospital and supports the related information systems functions.

PHYSICAL DEMAND

Located at Corporate office in New Haven with direct supervisor and some other departmental staff. Must work with other Hospital staff who are off-site from New Haven.