The Director of Government Reimbursement will oversee all government reimbursement reporting requirements including Medicare & Medicaid cost reports, Disproportionate Share Hospital (DSH) application, Uncompensated Care application and the Children's Hospital Graduate Medical Education (CHGME) funding application and annual reporting as well as all audits of these reports. This position will be responsible for monitoring, interpreting and applying Medicare and Medicaid laws and regulations. This position will also be responsible for working with external auditors on the CHST audit along with regulatory audits by HHSC or other governmental entities.
- Typically provides leadership to managers and /or higher - level professional staff.
- Typical span of control: Administrative 5-8, Clinical 6-8, Support Services 6-8; e.g. Admin: Fin, IT, Legal, HR, Public Affairs; Support Services: EVS, Security, Engineering, Food Services.
- Typically accountable for the performance and results of multiple teams performing related activities.
- Develops long-term plans and strategies for area of defined responsibility aligned with established functional strategies, and works with subordinate managers to operationalize and execute the strategy.
- Communicates priorities and expectations, monitors progress, and provides direction and course corrections along the way.
- Makes decisions guided by resource availability and functional objectives that affect the results of the function.
- Analyzes key trends and input from individuals in the team to make meaningful changes that directly and significantly affect short-term results.
- Establishes budgets and holds subordinate managers accountable for managing to achieve expected financial results.
- Works on cross functional teams to develop and implement solutions that have a broad impact on the organization's operations and processes.
JOB SPECIFIC RESPONSIBILTIES:
Manages a staff of two professional reimbursement Sr. Staff members.
- Ensures compliance with federal and state government regulations by coordinating and reviewing the annual Medicare & Medicaid costs reports and all supplemental reporting. This responsibility has a direct impact on a significant portion of the hospital's net revenue.
- Facilitates communication with appropriate government agencies, consultants, and organization departments to ensure the accuracy, transparency and compliance with State, Medicare and Medicaid regulations.
- Oversee and review the preparation, filing and audits of CHST's Medicare & Medicaid costs reports for the Dallas, Plano and OCH campuses.
- Represents the organization on all government reimbursement audits, including the annual Medicaid cost report audit and the Medicare cost report audit. Identifies ways to maximize reimbursement through proper reporting of costs and appeals of adverse adjustments. Also coordinates any other government reimbursement reporting such as the State Medicaid DSH audit and Uncompensated Trauma Care audits.
- Oversee and review the preparation of the DSH / Uncompensated Care tool ensuring compliance with all related rules and regulations. Maintains knowledge of DSH / Uncompensated Care funding regulations and ensure accurate reporting for maximum funding to the hospital. This program funds an average of $60 million plus annually.
- Oversee and review the preparation of the CHGME funding application, annual report, and audit processes related to the federally managed program. Maintains knowledge of CHGME funding regulations and ensures accurate reporting for maximum funding to the hospital. This program funds an average of $6.0 - 9.0 million annually and is the only revenue received to offset costs related to the pediatric graduate medical education program at Children's.
- Conducts research and plans according to changes in government reimbursement and tax regulations, advising senior management on the impact of proposed and enacted legislation.
- Ensure appropriate internal controls are present and documenting those internal controls as related to government reimbursement and reporting.
- Other duties as assigned by senior management.
- 2-3 years related experience, required.
- 3-4 years related experience, preferred.
- High school diploma or equivalent, required.
LICENSES AND CERTIFICATIONS:
- State CFC license, preferred.
SPECIFIC KNOWLEDGE, SKILLS, & ABILITIES:
- Maintain effectiveness when experiencing major changes in work responsibilities or environment; adjust effectively to work within new work structures, processes, requirements, or cultures.
- Use appropriate interpersonal styles to establish effective relationships with customers and internal partners; interact with others in a way that promotes openness and trust and gives them confidence in one's intentions.
- Ensure that the customer perspective is a driving force behind business decisions and activities; craft and implement service practices that meet customers' and own organization's needs.
- Develop and use collaborative relationships to facilitate the accomplishment of work goals.
- Identify and understand issues, problems, and opportunities; compare data from different sources to draw conclusions; use effective approaches for choosing a course of action or developing appropriate solutions; take action that is consistent with available facts, constraints, and probable consequences.
- Take prompt action to accomplish objectives; take action to achieve goals beyond what is required; be proactive.
- Deal effectively with others in an antagonistic situation; use appropriate interpersonal styles and methods to reduce tension or conflict between two or more people.
- Effectively manage one's time and resources to ensure that work is completed efficiently.
- Accomplish tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time.
- Set high standards of performance for self and others; assume responsibility and accountability for successfully completing assignments or tasks; self-impose standards of excellence rather than having standards imposed.
- Assimilate and apply new job-related information in a timely manner.
- Clearly convey information and ideas through a variety of media to individuals or groups in a manner that engages the audience and helps them understand and retain the message.