Director, Government Reimbursement

Job Description

Position will provide primary leadership and support to the Governmental Reimbursement function for UC Health. Primary areas of focus include governmental hospital cost report review and oversight of preparation, home office cost report preparation, HCAP filings and audit, key contact for the Medicare Administrative Contractor (MAC) oversight with primary management of audit submission deadlines and assignment of tasks, work with consultants/auditors to resolve reimbursement issues and present on strategic planning advice to senior leaders for the organization and hospital sites.

Provide budgetary input and full analysis on all reimbursement assumptions. Support monthly net revenue analysis related to governmental reimbursement and management of Medicare and Medicaid third‑party liability accounts. Provide strategic direction to the system related to governmental reimbursement and applicable trends and provide coordinated leadership with the Corporate Controller related to community benefit reporting. Leader serves as gatekeeper to the department and interfaces with pertinent teams and senior leadership throughout the year to provide education and awareness on governmental reimbursement items and regulatory changes.

United States

• Minimum
  
  Required:
  
  Bachelor’s Degree in Business Administration (Accounting/Finance‑Preferred)
• Preferred:
  Master’s Degree; MBA
• Preferred: 6–10 Years equivalent experience

• Cost Reporting
  • Supervise the preparation and review of governmental cost report filings, including management of outside consultants.
  • Track and report status updates, obstacles, and project plans to ensure timely completion of all regulatory filings.
• Internal Functional Resource
  • Act as lead system liaison to fiscal intermediaries and carriers pertaining to audits, appeals and negotiations, coordinating assignment of tasks and deadline‑driven submissions.
  • Review and interpret legislative changes to governmental reimbursement programs and provide routine updates to system leadership groups.
  • Provide direction on government reimbursement related issues and questions, quantifying the impact of clinical and strategic program proposals.
  • Provide analysis and direction to the annual operating budget and input on all relevant governmental reimbursement assumptions and activity.
• Strategic Planning
  • Work with outside auditors and consultants to resolve reimbursement issues and provide strategic planning guidance relative to governmental reimbursement and future trends.
  • Track and report status updates, obstacles and project plans to ensure timely completion of all regulatory filings.
• State‑Directed Payment Functions – HCAP filings
  • Direct the government reimbursement team in data pulls and timely submission of state‑required HCAP filings and audits.
  • Review the Hospital Franchise Fee (HFF), Hospital Additional Payments (HAP), and HCAP assessment amounts and the internal processing of the assessment amounts in a timely manner to the appropriate personnel.
  • Monitor Ohio Hospital Association (OHA) communications on a regular basis that pertains to HCAP, HAP, and HFF assessments and payments. Share these with appropriate personnel for budget forecasts, revised monthly expense accruals, and cash management.
• Staff Management
  • Train, supervise and hire staff.
  • Assist in the resolution of personnel issues for all areas including hiring, terminating and disciplining associates.
  • Ensure necessary training and development for staff is provided and monitor performance progress, including annual staff evaluations.
• Corporate Finance Interactions
  • Review governmental third‑party liability accounts after guiding team members through completion.
  • Coordinate regulatory‑driven components of the system’s annual community benefit reporting.