Job Information
Lawrence General Hospital System Director of Reimbursement in Lawrence, Massachusetts
JOB PURPOSE: The Director of Reimbursement fulfills a number of roles relating to the Hospital’s revenue cycle; these include: • Support the financial strategic planning process by monitoring and analyzing hospital revenues. • Monitor and assess the impact of federal, state, and other third-party insurer payment policies upon the Hospital. • Oversee the preparation of the annual cost reports and other governmental/third party insurer filing requirements to assure that Hospital revenues are appropriate and compliant with applicable regulation and contract provisions.
DUTIES AND RESPONSIBILITIES: 1. Is responsible for accounting, reporting, interpretation and monthly analysis of accounts receivable, related contractual allowances, third party settlements and NPSR; identifies variances in accounts receivable, contractual allowance and revenue accounts and resolves systematic problems. 2. Manages the operation of the contractual model to calculate monthly revenue estimates, contractual allowances, and reserves. 3. Prepares the monthly and year end third party settlements model 4. Prepares the monthly and year end Health Safety Net (HSN) revenue model 5. Oversees the compilation and submission of Federal and State cost reports 6. Coordinates and prepares accurate and timely submission of specific external audits including the annual Medicare cost report, the Uniform Medicaid and Uninsured Uncompensated Care Cost and Charge Report (UCCR), and the Massachusetts Center for Health Information and Analysis (CHIA) cost report 7. Manages external cost report inquiries and audits, with a goal of minimal adjustments 8. Oversees the maintenance and management of the Charge Description Master (CDM) and departmental charge mechanisms, including coordination of processes with department managers. 9. Monitors Federal, State and other third-party regulations and changes in payment policy and implements changes as needed to assure a high level of billing compliance. 10. Manages consulting projects related to Medicare disproportionate share, Transfer DRG reimbursement, and Medicare Advantage Graduate Medical Education, acting as liaison between the Hospital and outside consulting firms. 11. Completes and strategically manages revenue/income related grants to support hospital operations 12. Assists in the annual budgeting process, including the development of the net revenue model 13. Supports the Hospital’s provider contracting department in the assessment of changes to payment rates and other contract provisions. 14. Assists other areas of fiscal services in responding to Hospital departments’ ad hoc requests, including preparation of revenue estimated for business planning purposes and reporting to external agencies (e.g., bond rating bodies, Commonwealth of Massachusetts Attorney General community benefit reporting, etc.) 15. Maintains responsibility for development and supervision of staff, as required
