Director, Research & Reimbursement
Tennessee Hospital Association
Finance & Accounting , Health Care , Marketing, Communications & Information Technology
Position Description / Responsibilities
Provides support and technical assistance to hospital and health system reimbursement specialists in the form of in-depth research, support, education and advocacy around issues of healthcare reimbursement and compliance, including managed care (commercial, Medicaid, and Medicare Advantage), TennCare, workers’ compensation, payment innovations, changes and methodologies and program integrity.
ESSENTIAL FUNCTIONS OF THE JOB:
- Provide in-depth research, support, education and advocacy for members around issues of healthcare financing and reimbursement. Serve as a resource and respond to member queries on these issues in a timely and effective manner.
- Work with hospitals to identify, research and then develop solutions to common issues that hospitals encounter with payers (commercial, Medicaid or Medicare Advantage).
- Collaborate with THA staff and external consultants to analyze and provide input into TennCare policy and reimbursement issues.
- Evaluate and provide feedback on payer proposals and plans to implement changes in payment methodology; educate members about the potential impact.
- Monitor changes in the Medicare Advantage program and communicate relevant information to members.
- Monitor proposed state changes to workers’ compensation payment methodology, fee schedule and rules. Identify concerns, develop recommendations and make reports for members, legislators and state regulatory authorities.
- Work with other states on national payer issues—including surveying members, developing policy responses to payers and meeting with national payers around administrative and operational issues.
- Communicate regularly with hospital members around current developments impacting reimbursement, providing education on changes as well as receiving input on their concerns.
- Provide in-depth research, support, education and advocacy for members around healthcare compliance issues and program integrity. Respond to member queries on these issues.
- Provide analysis of hospital financial and operational impact of proposed program or regulatory changes.
- Support the annual THA Compliance Conference by developing agenda topics and presentations, identifying guest speakers and assisting with logistics.
- Must have the ability to adapt to a changing work environment and meet challenges presented throughout the day.
- Must be available for out-of-town travel approximately 10 percent of the time, be able to drive an automobile and maintain a valid driver’s license. Must travel both within and out of the state for various meetings as needed.
Educational and Experience Requirements Needed to Perform the Duties of the Job:
- Bachelor’s degree in accounting, finance, business administration or related field or equivalent work experience required.
- At least five years’ experience working in managed care, revenue cycle or similar reimbursement/contracting roles. Detailed knowledge of managed care required. Hospital and system operations experience strongly desired.
Licensing or Other Special Certifications Required:
Healthcare compliance certification desired
Skills Required to Perform the Duties of the Job:
- Understanding of hospital or healthcare operational, technical, regulatory and contractual issues and procedures.
- Must be analytical and able to ascertain and process facts related to a potential concern and determine whether an issue needs to be escalated.
- Must have strong research and problem-solving skills.
- Must have great customer service skills and be able to respond quickly, accurately and professionally to hospital and health system members.
- Ability to work constructively with payers and maintain positive working relationships while advocating for hospital members.
- Must have excellent written and verbal communication skills.
Please submit your resume and apply here.