Regulatory Reimbursement Coordinator

To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.

Responsible for the coordination of the hospital reimbursement function, including accounting, analytic, technical, regulatory and information systems support. Coordinates the annual cost report preparation, supporting documentation, filings and audits. Facilitates the successful resolution of cost report appeals and settlements and maintains good relationships with outside auditors. Leads multi-disciplinary work groups on projects associated with Reimbursement. Serves as technical advisor on reimbursement matters to Hospital and System management. Participates in monthly and annual financial statement preparation related to net revenue and accounts receivable. Coordinates the work of others on numerous, simultaneous projects. Works to assure the accuracy and accountability of reported reimbursement information to the public and governmental agencies. Supports special audits as required. Supports and enhances the compliance effort of the Hospitals and the System. Supports the efforts of the System Business Office in accurate and timely billing and cash collections.

EEO/AA/Disability/Veteran

• 1. Coordinates all projects and staff associated with the Reimbursement function, including annual cost report preparation, maintenance of accurate and comprehensive supporting information, timely, accurate and compliant filings, analysis and audit support.
• 2. Maintains advanced knowledge on reimbursement rules, regulations, and policy. Serves as technical advisor on reimbursement issues. Stays abreast of routine developments in Reimbursement.
• 3. Coordinates the challenge to and appeal of cost report findings for successful resolution. Drafts alternatives or options for consideration by management, recommends best technical strategy and approach. Drafts appeal documents and position papers. At times, negotiates with auditors to remove or challenge findings or appeal issues.
• 4. Coordinates the monthly and annual net revenue computations, valuation, projects and staff associated with same. Includes coordinating budget assumptions, maintaining detailed computer models, financial analysis, financial forecasting, recording and assuring the accuracy of accounting entries, reconciliations and investigation of variances as required.
• 5. Coordinates the Due to Third Party schedule supporting the Hospital's balance sheet through issue identification, account valuation, supporting workpapers and computations, and preparation of accounting entries and balances.
• 6. Coordinates a monthly Reimbursement project inventory and workplan, including project description, timeframes, future planning requirements and staffing recommendations.
• 7. Coordinates efforts of multi-disciplinary groups responsible for projects involved in the management and enhancement of Reimbursement, as required. At times, will be expected to lead these groups. Groups may include representatives from various clinical areas, Accounting, Coding, Medical Records, Billing, Utilization Management, Compliance, and Information Systems and staff from other organizations such as the School of Medicine or competitor hospitals. At other times, is required to work closely with clinical, Compliance and other Finance colleagues on a number of different Reimbursement projects.
• 8. Works to assure the accuracy and accountability of Reimbursement information reported externally to outside auditors, governmental agencies and the public. Works to ensure that underlying Information Systems related to Reimbursement and Billing are accurate and comprehensive.
• 9. Supports and enhances the Compliance efforts of the Hospital and the System.
• 10. Supports the efforts of the System Billing Office in accurate and timely billing and cash collections.
• 11. Analyzes current Reimbursement information, supporting documentation and data capture methods for purposes of identifying systemic and departmental opportunities for improvement and enhancement.
• 12. Participates in guidance to and support of administrative or clinical departmental needs on questions, process, status changes or updates to Reimbursement requirements, protocols and regulations.
• 13. Researches and resolves Reimbursement questions or issues.
• 14. Participates in communication of routine updates to rates or regulations affecting net revenue to management and affected clinical and administrative departments.
• 15. Coordinates the work of more junior staff.
• 16. Coordinates numerous projects simultaneously, and is engaged as lead analyst on several at the same time.
• 17. Promotes the Corporate philosophy of positive customer relations.
• 18. Performs other duties as required.

EDUCATION

B.A. or B.S. in Accounting, Finance, Health Care Administration, Mathematics, Information Systems or similar field required.

EXPERIENCE

Five or more years of experience in health care finance, reimbursement, public or other accounting, auditing, budget, compliance, billing or insurance required with progressive responsibility in supervision and project management.

SPECIAL SKILLS

Significant knowledge of reimbursement rules, regulations and accounting and auditing theory is assumed. Assumes working knowledge in the field of health care, including experience with billing, coding and working with clinicians. Demonstrated ability to lead groups and work on numerous projects simultaneously. Assumes some knowledge of decision support theory and concepts, experience with databases, data manipulation and familiarity through prior use, of database software programs such as Access. Ability to influence and direct the thinking of others and deal with all levels of management and different types of staff.

PHYSICAL DEMAND

Located at Corporate office in New Haven with direct supervisor and some other departmental staff. Must work with other Hospital staff who are off-site from New Haven.