Reimbursement Services Director directs and supervises the activities of the claims and provider reimbursement personnel. Handles third-party reimbursement for services rendered to patients. Being a Reimbursement Services Director sets procedures for filing reimbursement claims and ensures timely and accurate claims payments. Monitors, evaluates and reviews all cost reporting in support of reimbursement claims. Additionally, Reimbursement Services Director develops policies and procedures compliant with fiscal and regulatory requirements. Oversees the collection of statistical and financial data needed for preparing annual and monthly health insurance reports. May require an advanced degree. Typically reports to top management. The Reimbursement Services Director typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. To be a Reimbursement Services Director typically requires 3+ years of managerial experience. (Copyright 2024 Salary.com)
Scope of Position
This position reports to the Senior Director, Finance Healthcare Reimbursement and is positioned on the finance leadership team at the Ohio State University Wexner Medical Center (OSUWMC), a complex academic medical center. This position provides direction and oversight for the governmental reimbursement department. The Reimbursement department is responsible for preparation of third-party report filings, including cost reports, appeals and payment calculations. It prepares monthly analysis of contractual and bad debt allowance accounts, including comparisons to the prior month and to budget. It is responsible for preparing the annual forecast of the third-party reimbursement for the budget and its analyses and maintains financial parameters on the hospitals case mix system to assure the integrity of financial reporting through the system. The department is responsible for the maintenance and development of payment factors, costing ratios and reporting formats and it performs variance analysis of third-party liability accounts and provides supporting work papers and documentation for documentation for third-party inquires and provides reimbursement and regulatory analysis in Medical Center projects. The department also works closely with the Government Affairs department, Quality
and Operations Improvement department, the graduate medical education department, and Transplant department in evaluating the cost/quality and feasibility of new and existing programs and in the preparation of weekly/monthly financial indicators by business unit, workflow processes and projects. The Director is responsible for the management and performance of the department including management of the professional staff and the workflow processes and projects with the department.
Position Summary
The Director, Reimbursement and Financial Analysis has primary management responsibility for providing the services noted in the Scope of Position Section. The Director possesses requisite managerial and technical abilities to provide leadership and direct staff in developing and maintaining systems, processes, workflows, and designs which support the hospitals and university finances. The position will direct the work of managers, accountants, clerical personnel, and students. The position will work with hospital management personnel, senior administrative personnel, physicians, and other members of the Financial Services management team.
Minimum Qualifications
Bachelors degree in business administration or related field with a major in Accounting or Finance required. CPA certification desirable. And/or MHA/MBA degree or equivalent combination of education and experience. Four to six years experience in hospital or health services management or finance, reimbursement and budgeting is required. Must be able to plan, manage and establish financial expertise in all areas covered by the above responsibilities. Must possess familiarity with data processing capabilities and procedures. Must have developed delegation skills and be able to present oral and written reports to all management levels.
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