Responsible for managing and overseeing the reimbursement activities for the Yale New Haven Health System. Ensures reimbursements are in compliance with appropriate rules and regulations. Works in collaboration with System finance departments to prepare the annual net revenue budget, forecasts and projections. Develops and maintains third party rate accounts for the YNHHS including coordinating the results of the rate account analysis with the appropriate Accounting Departments. Assures Medicare and Medicaid third party reimbursement rates are utilized by the Business Offices and oversees the indemnity rates as they are issued. Manages all third party governmental audits and the subsequent review of settlements as a result of these audits. Develops and manages relationships with consultants, governmental payors, and our Managed Care Division to pursue all avenues of appropriate reimbursement. Responsible for effectiveness and accuracy of cost report filings. Manages reimbursement appeals with third party payors to insure full compliment of potential reimbursement is achieved and revenue is protected. Manage the chargemaster file, charge capture activities, and pricing strategies working with the clinical departments and the System Business Office to achieve the complete reimbursement for services rendered.

Responsibilities

• Responsible for the filing and review of all YNHHS' Hospital cost reports to determine reimbursement impacts and compliance with appropriate rules and regulations (e.g., Medicare, Medicaid, OHCA, CHAMPUS).
• Oversee and organize the filing of all individual Hospital reimbursement appeals with third payers to enhance and retain reimbursement.
• Work in close collaboration with existing resources within the YNHHS' Hospital Financial Planning and Budgeting Departments in preparation of annual revenue budgets.
• Responsible for all aspects of reimbursement related to graduate medical education throughout the YNHHS.
• Responsible for coordinating with clinical departments for revenue opportunities and reimbursement updates.
• Responsible for providing updates and actively participation as a member of the Revenue Cycle Management Steering Committee as well as ensuring reimbursement considerations are addressed at other committees and ad hoc meetings.
• Oversee the preparation and maintenance of third party rate accounts for all of YNHHS Hospitals. Coordinate the results of the rate account analysis with the appropriate General Accounting Departments. Ensures procedures and documentation are in accordance with the requirements for auditors.
• Administer the review of Medicare, Medicaid, and indemnity rates as they are issued. Assure that proper Medicare and Medicaid third party reimbursement rates are utilized in the Accounts Receivable Billing Systems and by Accounting in producing the monthly financial statements.
• Oversee all third party governmental reimbursement audits and subsequent reviews of settlements as a result of these audits.
• Promotes the YNHHS Corporate Services Service Excellence initiatives.
• Coordinate with System wide decision support resources in connection with data analysis, net revenue calculations, and reconciliations.
• Support System wide General Accounting Departments with monthly close processes.
• Develops and manages relationships with consultants, governmental payors, and our Managed Care Division to pursue all avenues of appropriate reimbursement.
• Work closely with the System Business Office on revenue projects with consultants, coordination with audits , reimbursement verification, and system interface issues with the chargemaster / claims processing.
• Responsible for modeling YNHHS impacts of proposed Medicare and Medicaid regulations.
• Responsible for maintaining consistency in cost report filings ensuring the full capture of reimbursement opportunities and assuring corporate compliance requirements are met.

Qualifications

EDUCATION

• Masters in Business Administration or related area strongly preferred; Bachelors in Accounting, Finance, or related area required.

EXPERIENCE

• Seven (7) to ten (10) years experience in healthcare reimbursements and revenue analysis including revenue accounting, regulatory compliance, billing/reimbursement and financial reporting.
• Three (3) to five (5) years' management experience over an accounting, reimbursement, finance, or budget area also required.
• Health System experience strongly desired.

SPECIAL SKILLS:

• Excellent knowledge of Healthcare revenue accounting systems and Government (CMS) regulatory billing and reimbursement requirements required.
• Ability to work effectively with all levels of management throughout multiple entities.
• Ability to provide management with relevant information to support financial objectives or identify areas for improvement.
• Excellent analytical and communication skills required.

YNHHS Requisition ID

186865