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Director Government Reimbursement

Company: Nuvance Health
Location: Danbury
Posted on: February 24, 2021

Job Description:

Nuvance Health is a family of award-winning nonprofit hospitals and healthcare professionals in the Hudson Valley and western Connecticut. Nuvance Health combines highly skilled physicians, state-of-the-art facilities and technology, and compassionate caregivers dedicated to providing quality care across a variety of clinical areas, including Cardiovascular, Neurosciences, Oncology, Orthopedics, and Primary Care.Title: Director, Gov't Reimbursement (NY)Reports To: AVP, Revenue and Reimbursement Department: FinancePurpose: Position is accountable for all external government reporting requirements to state and federal government programs with specific emphasis on Medicare and Medicaid cost reporting filings and government audits. Emphasis on the preparation of filings with a focus on regulatory compliance. In addition, the Director is responsible for supporting ongoing operations as needed inclusive of revenue close processes, revenue budget modeling, CDM pricing, determination of reserve levels, and modeling impact analysis from government regulatory changes.Essential Responsibilities* Oversee the collection of all required cost data related to third party reimbursement and preparation of the Hospitals' & affiliates' cost reports. Including, identifying all required cost report filings and meeting all respective due dates.* Coordinate the completion and assignment of worksheets for the cost report(s) and all other reporting (i.e. HCRA reporting and NYS Cash Assessment) to all staff and provides education and training as needed. Perform theoretical and analytical review of cost report, identifying potential settlement issues, the impact of rate changes, or reimbursement opportunities prior to reviewing with management.* Proactively reviews healthcare financial websites (HANYS, GNYHA, CMS, etc.) and attend seminars to stay abreast of changes in healthcare finance and reimbursement and communicates issues to staff.* Act as principal contact in external audits of cost reports by providing supporting documentation and analysis.* Preparing, organizing, and presenting all arguments and appeals to the Fiscal Intermediary and the Provider Reimbursement Review Board.* Reviewing Medicare audit reports to seek opportunities for adjustments or appeals.* Establishes third party reserves for each entity based upon regulatory changes and cost report settlements.* Oversee the monthly analyzes of the revenue work papers to ensure proper financial statement reporting and accurate charge capture, while providing clear explanations for variance to budget based on volume and rate.* Acts as principal contact in internal/external audits of cost reports and year-end audits (specific to third party reserves) by providing supporting documentation and analysis.* Responsible for updating the payment factors in the applicable proration system for government payers to be able to calculate the correct expected reimbursement at the time of billing.* Educating and managing the physician time study process to ensure compliance with all regulatory requirements.* Stay abreast of reimbursement issues affecting the facilities and effectively communicates changes and the impact of changes.* Participate in committees and attend meetings as periodically assigned.* Responsible for the development and training of staff & performance reviews.* Fulfills all compliance responsibilities related to the position.* Maintain and Model Nuvance Health Values.* Demonstrates regular, reliable, and predictable attendance.* Performs other duties as required.* QualificationsEducation and Experience Requirements:* Advanced experience in Hospital government reimbursement. Medicare Cost Reporting and audit experience desired.* Bachelor's degree in accounting, finance, or business administration is required. Minimum 5 years' experience Acute Care reimbursement. Master's Degree or equivalent experience preferred.* Minimum 3 years management experience.Minimum Knowledge, Skills And Abilities Requirements* Advanced knowledge in Crowe, HFS, EPSI. In addition, word, excel, and general database knowledge.* License, Registration, Or Certification Requirements* n/aWE ARE AN EQUAL OPPORTUNITY EMPLOYER. Qualified Applicants are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status, or any other classification protected under applicable Federal, State or Local law.

Keywords: Nuvance Health, Danbury , Director Government Reimbursement, Accounting, Auditing , Danbury, Connecticut

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