Director - Reimbursement - Acute

UHS • $120K — $150K *
King Of Prussia, PA 19406In-Person
Healthcare
8 - 10 years of experience
1 week ago
Job Overview by Ladders

Qualifications

  • Bachelor's degree with 10+ years of expert experience in cost reporting applications
  • Comprehensive knowledge of Medicare payment systems such as DRGs and APCs
  • Thorough understanding of Medicare statutes and regulations
  • Expertise in Medicare alternate payment concepts, specifically Bundled Payments
  • Familiarity with Quality-based reimbursement concepts, including Value-Based Purchasing
  • Proficient knowledge of Medicare DSH and S-10 regulations
  • Intermediate-to-advanced Microsoft Excel skills

Responsibilities

  • Complete Medicare and Medicaid cost report submissions for multiple facilities
  • Provide independent consulting services on hospital reimbursement to various UHS entities
  • Oversee Medicare alternate payment methodology for UHS acute care hospitals
  • Develop reimbursement aspects related to quality-based payment methodologies
  • Participate in SEC disclosures related to Medicare and Medicaid programs
  • Review Medicare and Medicaid contractual models for compliance
  • Monitor legislative activity related to Medicare and Medicaid

Benefits

  • Rewarding career opportunities with professional development
  • Challenging work environment with growth potential
  • Competitive compensation structure
  • Medical, Dental, Vision, and Prescription Drug Plan
  • 401(k) retirement plan with company match
Full Job Description
Responsibilities

The UHS Corporate Reimbursement Department is hiring a Director - Reimbursement - Acute to oversee Medicare-related payment activity that includes but is not limited to the reimbursement aspects of (1) Medicare alternate payment models (e.g. Bundled Payments) and (2) Quality Based payments such as Value-Based Purchasing, Hospital Acquired Conditions, Excess Readmissions and other quality based payment methodologies.

Key Responsibilities include:
  • Complete Medicare and Medicaid cost report submissions for assigned hospitals or other UHS entities and related desk review and audit activity (including wage index reviews or other Medicare/Medicaid reimbursement activity) for multiple facilities with complex reimbursement environments and that have a high level of financial statement impact. Handle all cost report PRRB appeal activity, as applicable
  • Provide independent on-going hospital reimbursement consulting services (e.g. compliance, billing, financial pro forma analysis) to UHS corporate business office, regional finance and to hospital executive staff and other UHS entities. Independently handles complex reimbursement projects and assignments
  • Oversee, coordinate and develop the reimbursement aspects of all UHS acute care hospital Medicare alternate payment methodology activity with a focus on Bundled Payments., as applicable
  • Oversee, coordinate and develops the reimbursement aspects of all UHS acute care hospital Medicare quality based payment methodology activity including but not limited to Value-Based Purchasing, Hospital Acquired Conditions, Excess Readmissions, etc., as applicable
  • Participate in UHS acute care hospital SEC "Sources of Revenue" disclosure (10-k and 10-Q) activity related to the Medicare program (and Medicaid programs, as needed); as applicable
  • Provide applicable Medicare and Medicaid contractual models, related reimbursement factors and other necessary data. Review these models for compliance and accuracy
  • Assist VP-Reimbursement with the monitoring of Medicare and Medicaid legislative, regulatory and administrative rule activity. Assist with drafting of FAH public comment and provide estimated UHS financial impact, as directed by VP-Reimbursement
  • Participates in the oversight, development and maintenance of Medicaid supplemental payment (SDP and UPL) and state Medicaid DSH programs for assigned facilities
  • Oversee the completion of Medicare DSH packages for assigned acute care division hospitals and handles all related audit activity in coordination with the hospital's designated Reimbursement Manager, as applicable
  • Oversee the completion of all Medicare DSH SSI ratio Cost Report Year End versus Federal Fiscal Year determinations and related activity, as applicable
  • Oversee the completion of the Medicare cost report S-10 worksheet data elements using external software and handles related Medicare and/or Medicaid audit activity. Provide recommendation for changes in hospital charity and other financial assistance policy(s) (FAP's) to ensure compliance with the applicable federal and/or state rules and regulations and optimization of related reimbursement, as applicable
Qualifications

Bachelor's degree with 10+ years' experience with expert knowledge of cost reporting applications and concepts.
  • Comprehensive knowledge of Medicare prospective payment systems including Inpatient Acute DRGs, Outpatient APCs, Rehabilitation CMGs, Psychiatric DRGs, Skilled Nursing RUGs and Long Term Care LTAC DRGs
  • Thorough understanding of Medicare statutes, regulations and administrative rules and their related legislative and regulatory processes
  • Thorough understanding Medicare alternate payment concepts with a particular focus on Bundled Payments
  • Thorough understanding of Quality based Medicare reimbursement concepts (i.e. Value-Based Purchasing, Hospital Acquired Conditions, Excess Readmissions, etc.)
  • Expert knowledge of Medicare Disproportionate Share Hospital (DSH) rules and regulations
  • Expert knowledge of Medicare S-10 Uncompensated Care (UC) rules and regulations
  • Understanding of Medicaid supplemental payments (SDP and UPL), Health-care Related Taxes and Medicaid DSH payments
  • Familiar with Medicare Provider Reimbursement Review Board (PRRB) Appeal Process
  • Intermediate-to-Advanced level knowledge of Microsoft Excel
  • Familiarity with Mckesson G/L and Siemens Invision
  • Proficiency in HFS cost report software (or its equivalent)

This opportunity provides a rewarding career, challenging and rewarding work environment as well as growth and development opportunities within UHS and its subsidiaries, including competitive compensation, excellent Medical, Dental, Vision and Prescription Drug Plan, and 401k with company match.

About UHS

UHS Careers

Joining UHS presents an unparalleled opportunity to become part of a leading team of healthcare professionals dedicated to making a difference. UHS, known for its commitment to innovation and leadership in the healthcare sector, offers a variety of job opportunities that cater to a diverse range of skills and experiences.

Explore Job Opportunities

UHS is actively hiring and offers a wide array of positions, from clinical roles to administrative support. Each position at UHS is designed to challenge team members while providing meaningful service to the community. Explore the current job openings and find a career path that suits professional aspirations and skills.

Internship Programs

UHS provides robust internship programs that offer hands-on experience in the healthcare industry. Internships are a cornerstone of professional development, giving participants a chance to deepen practical skills in a real-world setting. These programs are tailored to foster growth and prepare interns for a full-time position within the company.

Professional Growth and Development

UHS believes in nurturing the career growth of its team members through comprehensive professional development programs. These include leadership training, diversity training, and continuous education in the latest healthcare practices, ensuring that every team member has the opportunity to advance their career.

Benefits and Culture

Employment at UHS comes with competitive benefits designed to support the health, well-being, and financial security of each team member and their families. The company culture at UHS is built on a foundation of respect and inclusion, where diversity is celebrated and every voice is heard.

Networking and Innovation

UHS encourages a culture of innovation where team members are motivated to bring forward ideas that drive improvement and efficiency. Networking within the company is supported through various events and internal platforms, helping team members to connect, share insights, and collaborate on projects.

Applying for a Position

To apply for a position at UHS, candidates should prepare their resume to highlight relevant experience and skills. The interview process at UHS is thorough, aiming to assess not only the professional qualifications but also the alignment with the company’s values and culture. Interested candidates can visit the UHS Careers page to submit an application and learn more about the hiring process.

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* Ladders Estimates

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