Director of Reimbursement at First Health Of The Carolinas in Pinehurst, NC

The Director of Reimbursement is responsible for providing strategic leadership, financial and administrative oversight for all reimbursement tasks for the Health System, including Medicare/Medicaid Cost Reporting, Managed Care Contracting, Chargemaster Strategies and analyzing reimbursement options. They also work closely with Finance, Revenue Cycle and Administration regarding reimbursement statuses, business planning and development.

Will develop and implement reimbursement strategy for the organization. Performs ongoing trend analysis on third party payment levels to ensure that reimbursement is in accordance with allowable amounts stated in agreements and contracts. Reviews and audits the third party adjustment model to ensure provider estimates are comprehensive and accurate. Review/analyze overall monthly provision for contractual and bad debt allowances. Perform hindsight testing to ensure the accuracy and integrity of the provision calculation. Prepares and utilizes financial analyses in third party and managed care negotiation payer process. Coordinates the submission ofall Medicare/Medicaid Cost Reports and related filings. Oversees the management and maintenance of the System Chargemaster. Monitors, reviews and negotiates third party payer contracts. Assists VP, Finance & CFOwith all projects within related scope of responsibility.

Seven years in healthcare reimbursement with intimate knowledge of Managed Care Contracting, Chargemaster, Medicare Cost Reporting, and related State and Federal filings experience required. Bachelor's degree required; Master's degree or CPA preferred. Excellent communication skills, both verbal and written are required. Must have ability to work with people at all levels of the organization. Demonstrated knowledge of managed care and value-based care principles required. Must have knowledge of different healthcare rate structures and payment methodologies.