Director of Third -Party Reimbursement

at Ann & Robert H. Lurie Children's Hospital of Chica in Lake Forest, Illinois, United States

Job Description

Ann & Robert H. Lurie Children's Hospital of Chicago provides superior pediatric care in a setting that offers the latest benefits and innovations in medical technology, research and family-friendly design. As the largest pediatric provider in the region with a 140-year legacy of excellence, kids and their families are at the center of all we do. Ann & Robert H. Lurie Children's Hospital of Chicago is ranked in all 10 specialties by the U.S. News & World Report.

Location680 Lake Shore Drive

Job Description

Responsible for ensuring that maximum reimbursement is received from all third-party payers, all required third party cost reports are prepared and submitted in an accurate and timely manner and all essential position functions are discharged in an efficient and effective manner.

Leadership Accountabilities:

Clinical Quality Outcomes
Establishes and maintains high standards for quality of care, & patient safety.
Takes initiative to improve both processes and outcomes, incorporating best practices, and innovations in professional field.
Ensures compliance with Lurie Children's policies and all accreditation & regulatory bodies and their standards.

Strategic Growth
Compellingly communicates to staff the critical role they play in achieving Lurie Children's mission and strategic goals.
Facilitates organizational change initiatives; leads and supports staff in adapting to a rapidly changing health care environment.
Facilitates development and achievement of professional & personal goals for self and staff.
Effectively recruits, orients, develops & retains a talented and diverse workforce.

Brand Identity
Strengthens our brand as a top tier provider and employer by establishing and maintaining high standards for excellence.
Models our values of service, innovation and teamwork. Holds others accountable for living these values.
Fulfills the Employee Promise by fostering a challenging & compassionate work environment, recognizing strong performance, and listening and acting on feedback.

Customer Satisfaction
Consistently models our Service Principles in internal and external interactions and ensures that the Service Principles are fulfilled to by others.
Ensures employees receive information needed to perform jobs including feedback to enhance performance and customer satisfaction.
Proactively addresses performance issues when indicated and administers policies, decisions, & disciplinary actions with consistency.

Financial Performance
Aligns department goals and manages department resources and budgets to meet Lurie Children's strategic objectives.
Helps others understand the drivers of financial success for department and Lurie Children's.

Area Specific Job Accountabilities:
Oversee the monthly contractual allowance and reserve analysis for all payers such as Medicaid, Medicare, Blue Cross and other managed care contracts (Hospital and Physician affiliates).
Prepares and compiles cost reports and other information as required by the federal and state laws and other third-party contractors.
Develops strategies to maximize reimbursement and limit exposure to billing and coding compliance issues and supports the arguments required to appeal adverse reimbursement decisions by third parties.
Supports third party contract negotiations through detailed analysis of activity, related costs and charges and assess the impact of managed care contracts on reimbursement and contractual allowances.
Responsible for interim financial statement reporting for revenue, revenue deductions, and bad debts.
Responsible for preparation of client prepared work papers and supporting documentation related to the year-end audit of contractual allowances, reserves and settlements.
Develops the annual budget for contractual allowances, charity care and bad debt.
Reviews and assesses impact to Medical Center of "proposed" and "passed" state and federal legislation.
Maintain cost-finding statistics used for third party reporting as it relates to the Patient Accounting System.
Assist in the preparation of the annual Form 990 Schedule H, the property tax exemption and sales tax exemption forms for the Hospital.
Ensures appropriate information is available from research and specific purpose funds for cost reporting and indirect cost proposals. Negotiates indirect cost rates with federal reviewers.
Acts as the Hospital liaison to fiscal intermediaries and other auditors during field audits and/or investigations regarding billing and reimbursement matters.
Maintains third party statistical information and supplies all revenue/statistics by payor for external sources and surveys.
Set goals and objectives, conduct the performance appraisal for and support the professional development of the Sr. Reimbursement Specialists. Supports accounting staff on technical matters related to reimbursement.
Supports Revenue Cycle... For full info follow application link.

EEO/AA Employer/Vets/Disability