SUMMARY: Creates, develops and implements processes and programs to assist the organization in improving and maximizing revenue and reimbursement streams, resource preservation, appeals and cost reporting; develops and implements strategies for program and funding enhancement with changing governmental and industry trends; oversees Reimbursement department operations and staff.

　　DUTIES & ESSENTIAL JOB FUNCTIONS: NOTE: The following are the duties performed by employees in this classification. However, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification.

　　Supervises staff and manages employee performance; provides on-going performance feedback, addresses problems, orients and trains employees, verifies competency and identifies and suggests ways to develop skills; monitors workflow.

　　Advises Chief Financial Officer and Vice President of Finance on regulatory matters impacting AHS’s governmental reimbursement. Analyzes and models financial and statistical data used in third party reimbursement related to hospital reimbursement or final settlements.

　　Develops and implements strategies for preserving and expanding governmental financing over time, accounting for local, state and federal policy changes, industry trends, and AHS services and data systems.

　　Assists in cash and management to determine operating and capital expenditures goals and expectations

　　Assists the Divisions of Patient Accounting, Financial Planning, Utilization Review and Healthcare Contracting to model the impact of rate increases, charge master changes, appropriate pricing and service line profitability.

　　Develops and maintains revenue accounting, modeling systems, revenue budgets, statistics collections, monitoring reports, and systems for variance reporting.

　　Oversees AHS compliance with regulatory guidelines issued by governmental agencies and third-party payers including financial reporting, federal wage-price and OIG guidelines, and third-party billing compliance.

　　Oversees full reconciliation of accounts receivable subsidiary ledgers/systems to the general ledger, including, but not limited to, government patient admission logs.

　　Oversees related third-party settlements, review cost report preparation and monitor audits and appeals; develop and oversees internal reviews of compliance with administrative and financial policies and procedures.

　　Participates in the valuation of account receivables.

　　Plans, coordinates, and manages periodic reimbursement related audits by internal and external and other auditors; leads reimbursement consultant(s) in the identification of appropriate appeals issues and annual cost report reviews; files formal appeals to maintain or improve reimbursement levels within the confines of federal and/or state regulations.

　　Prepares accruals for estimated Medicare, Medi-Cal, and third-party payer contractuals and bad debt allowance; projects and reconciles periodic Medicare interim (PIP) payments.

　　Prepares and presents complex analyses and reports; participates, plans and strategizes for third party payer contracts.

　　Prepares the annual net patient revenue and supplemental payments budget.

　　Oversees full reconciliation of supplemental government reimbursement.

　　Reviews and presents financial and statistical reports required for cost reimbursement, prospective reimbursement or Alternative Payment Methodology reimbursement and HCAI reports to government and third-party agencies.

　　Researches and develops potential avenues for securing new streams of permanent and supplemental funding (i.e., fee-for-service, Medi-Cal managed care, waivers).

　　Performs other duties as required.

　　Any combination of education and experience that would likely provide the required knowledge, skills and abilities as well as possession of any required licenses or certifications is qualifying.

　　MINIMUM QUALIFICATIONS:

　　Required Education: Bachelor’s degree from an accredited college or university.

　　Preferred Education: Master’s degree in business, accounting, economics, public policy, public administration, or related field

　　Required Experience: Seven years of administrative and/or policy experience in health-related reimbursement functions or programs, including analyzing, evaluating, coordinating and implementing organizational programs; experience working with hospital government reimbursement reporting including Medicare and Medi-Cal.

　　Preferred Experience: Reimbursement experience with California public hospital or health system; experience with policy development, including Medicaid financing and waivers, the Affordable Care Act, state and federal health policies and budgeting, and state and federal health-related legislation and regulations; experience with interpreting state and federal laws and regulations relating to healthcare systems and funding programs; experience advocating comprehensive improvements for multiple Medicaid and other health programs and public hospital systems’ funding.

　　Preferred Licenses/Certifications: HFMA or related professional organization certification.