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8160 DIR REIMBURSEMENT


Work Schedule/Days:  Day / Monday - Friday 
Employment Type:  Full-Time

JOB SUMMARY

The Director, Reimbursement provides direct operational and financial leadership, and accountability for compliance, reporting, and planning associated with participation in government programs. They are responsible for maintaining knowledge of government program requirements, facilitating the development of systems and processes to maximize reimbursement, supporting compliance efforts, and assessing financial and operational impact of proposed government program changes.

 

This leader participates with operational leaders in new program development or changes to established programs to ensure compliance with government program requirements.  They coordinate and ensure the accumulation of financial and operational data for preparation and/or participation in external financial surveys. The Director Reimbursement reports to the VP, Corporate Finance and leads a team of four reimbursement professionals.  

JOB RESPONSIBILITIES*

  • Maintains knowledge of government program (e.g. Medicaid, Medicare, State Children’s Health Insurance Program, Children’s Hospital Graduate Medical Education, Indigent Care Trust Fund, etc.) requirements and their related financial impact on Children’s.
  • Develops systems and processes to monitor compliance with government program requirements.
  • Prepares and/or participates in the completion of external financial surveys/reports (e.g. Children’s Hospital Association, Hospital Financial Survey, Disproportionate Share Hospital Survey, Annual Hospital Questionnaire, Medicaid Cost Report, etc.).
  • Develops tools, systems and processes to accumulate data (payor mix, indigent and charity care allowances, cost reporting statistics, etc.) to support decision-making and reporting for government program and external surveys.
  • Provides training to Children’s staff pertaining to government program reporting requirements and reimbursement methodologies.
  • Reviews accounts receivable balances and ensures adequate balance sheet reserves.
  • Reviews and evaluates net revenue on a monthly basis to identify opportunities for improvement, contributors to budget variances and key trends.
  • Participates in financial planning pertaining to payor mix, reimbursement rates, contractual adjustments, bad debts and other discounts.
  • Interacts with external agencies to advocate for optimal reimbursement for pediatric care.
  • Represents Children’s with external agencies to ensure appropriate settlements and timely administrative review requests, appeals, and hearings.
  • Monitors and manages Medicaid outlier reimbursement.
  • Collaborates with Revenue Cycle in optimizing coding, billing and resolution of payment discrepancies.

EXPERIENCE*

  • Seven (7) or more years of third-party reimbursement experience in a hospital setting, with at least three (3) years leading a function.
  • Demonstrated experience in developing processes, procedures and policies that positively impact efficiencies.

 

EDUCATION

  • Bachelor’s Degree in Business Management, Accounting or Finance

KNOWLEDGE SKILLS & ABILITIES*

  • Extensive knowledge of hospital operations is required.
  • Must have outstanding business and financial acumen.
  • Strong interpersonal skills in an environment that encourages collaboration.  Excellent influencing and interpersonal skills as well as aptitude for conflict resolution, problem-solving, strategic thinking and flexibility.
  • Demonstrated ability to build strong, sustainable, partnering relationships.
  • Outstanding analytical ability is required. Able to quickly, yet thoroughly, determine needs, cost/benefits, risks, and mitigations.
  • Demonstrated listening, problem solving, prioritization, organization, sensitivity, positive behavior, high values, and negotiating skills and aptitudes.
  • Ability to effectively cope with change and can shift gears comfortably. Willing to shift between strategy, design, and delivery. Does whatever is needed to get the job accomplished.
  • Highly effective in ambiguous environment and able to produce maximum results with little direction and guidance.
  • Excellent project management skills including planning, logistics, program management, scheduling, and budget adherence.
  • Strong communicator with excellent verbal, written, and presentation skills. Able to simplify complex topics so the uninformed end user can understand.
  • Self-motivated high achiever with proven ability to manage multiple, strategically critical projects and timelines.

PREFERRED QUALIFICATIONS*

  • Masters degree strongly preferred.
  • CPA, CPAM, or FHFMA certification is strongly preferred.

CERTIFICATION SUMMARY

  • No professional certifications required

SYSTEM RESPONSIBILITIES*

Safety: Practices proper safety techniques in accordance with hospital and departmental policies and procedures. Responsible for the reporting of employee/patient/visitor injuries or accidents, or other safety issues to the supervisor and in the occurrence notification system.

 

Compliance: Monitors and ensures compliance with all regulatory requirements, organizational standards, and policies and procedures related to area of responsibility. Identifies potential risk areas within area of responsibility and supports problem resolution process. Maintains records of compliance activities and reports compliance activities to the Compliance Office.

 

The above statements are intended to describe the general nature and level of work performed by people assigned to this classification.  They are not intended to be an exhaustive list of all job duties performed by the personnel so classified.

 

About Us:

Children’s Healthcare of Atlanta has been 100 percent committed to kids for more than 100 years. A not-for-profit organization, Children’s is dedicated to making kids better today and healthier tomorrow.

With 3 hospitals, 28 neighborhood locations and a total of 638 beds, Children’s is the largest healthcare provider for children in Georgia and one of the largest pediatric clinical care providers in the country. Children’s offers access to more than 70 pediatric specialties and programs and is ranked among the top children’s hospitals in the country by U.S. News & World Report.

Children’s has been ranked on Fortune magazine’s list of “100 Best Companies to Work For” for thirteen consecutive years and named one of the “100 Best Companies” by Working Mother magazine. We offer a comprehensive compensation and benefit package that supports our mission, vision and values. We are proud to offer an array of programs and services to our employees that have distinguished us as a best place to work in the country. Connect to our mission of making kids better today and healthier tomorrow. 

Have questions about the recruitment process?  Check out What to Expect.

Requisition #:  29388     
Location:  Park North - Harvard  -  3395 Northeast Expressway, Atlanta, GA  30341
Function:  Leadership/Management - Director/Senior Director