REGIONAL DIRECTOR, REIMBURSEMENT (OHIO)
LOCATION: Columbus, Ohio
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.
1. Knows, understands, incorporates and demonstrates the Trinity Health Mission, Vision and Values in leadership behaviors, practices and decisions.
2. Prepares the department budget and manages use of resources within budget targets.
3. Responsible for hiring, retaining, evaluating, mentoring and firing managers and staff within the department.
4. 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.
5. 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.
6. Manage the overall balance sheet position related to third party contractuals and related reserves. Provide updates to Senior Leadership to avoid any surprises.
7. 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.
8. Develops strategic reimbursement planning and analysis for short and long-term operating plans and capital projects (for acute and professional activities).
9. 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.
10. Develops and implements policies and procedures to ensure reimbursement procedures, practices and reporting adhere to compliance regulations.
11. 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.
12. Provides education and consultation to staff to ensure accuracy of third party reporting. Maintains expertise in reimbursement strategies through appropriate educational and organization activities.
13. Directs year end audit preparation for reimbursement issues ensuring the continued integrity of financial records through the design and implementation of appropriate controls.
14. Participates in RHM management and staff meetings to provide reimbursement support.
15. 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.
16. 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.
17. Participates in the negotiation, implementation and ongoing review and monitoring of contracts with third party payors and managed care entities.
18. 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.
19. 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.
As a Trinity Health Leader, the incumbent is expected to demonstrate leadership traits which support our Mission Statement and Core Values as identified below:
Mission Statement: We, Trinity Health, serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities.
• Reverence: We honor the sacredness and dignity of every person.
• Commitment to Those who are Poor: We stand with and serve those who are poor, especially those most vulnerable.
• Justice: We foster right relationships to promote the common good, including sustainability of Earth.
• Stewardship: We honor our heritage and hold ourselves accountable for the human, financial and natural resources entrusted to our care.
• Integrity: We are faithful to those we say we are.
1. Bachelor’s degree in Business Administration, Accounting or Finance or an equivalent combination of education and experience. Master’s degree is preferred.
2. Certification as a Certified Public Accountant (CPA) preferred.
3. Over ten (10) years of progressively more responsible experience in health care reimbursement management. Experience managing multiple facilities preferred.
4. Ability to develop and interpret financial statements and reports.
5. Working knowledge of generally accepted accounting principles and a thorough understanding of third party reimbursement mechanisms and contracting strategies.
6. Ability to communicate in clear, concise terms with management and governance at all levels, including communication with C-Suite executives.
7. Ability to work effectively in a matrix organizational structure and influence others.
8. Well-developed conceptual and analytical skills.
9. High level of interpersonal, management and organizational skills are necessary with special focus on customer service orientation skills.
10. Must be able to operate effectively in a collaborative, shared leadership environment.
11. 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.
PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS
1. Flexibility to work with a multitude of customers and issues and willingness to take on new responsibilities.
2. Ability to develop constructive alternatives and analyze situations and information.
3. Ability to work well in a fast-paced setting that warrants varied and/or extended hours, with frequently changing workload and priorities in order to keep pace with the environment and advance strategic priorities.
4. Operates in an office environment free from hazards and barriers. Manual dexterity is needed to operate a computer and calculator.
5. Must be able to set and organize own work priorities, and adapt to them as they change frequently.
6. Must be able to adapt to frequently changing work priorities, and be able to prioritize and balance the requirements of working with the System Office and Regional Health Ministries (RHMs).
7. Must be able to travel to the various Trinity Health sites (20%) as needed (may or may not apply).
The above statements are intended to describe the general nature and level of work being performed by persons assigned to this classification. They are not to be construed as an exhaustive list of duties so assigned.