Director, Research & Reimbursement

Tennessee Hospital Association

Brentwood, TN

Finance & Accounting , Health Care , Marketing, Communications & Information Technology


Position Description / Responsibilities

JOB SUMMARY:

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:

  1. 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.
  2. Work with hospitals to identify, research and then develop solutions to common issues that hospitals encounter with payers (commercial, Medicaid or Medicare Advantage).
  3. Collaborate with THA staff and external consultants to analyze and provide input into TennCare policy and reimbursement issues.
  4. Evaluate and provide feedback on payer proposals and plans to implement changes in payment methodology; educate members about the potential impact.
  5. Monitor changes in the Medicare Advantage program and communicate relevant information to members.
  6. 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.
  7. 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.
  8. Communicate regularly with hospital members around current developments impacting reimbursement, providing education on changes as well as receiving input on their concerns.
  9. Provide in-depth research, support, education and advocacy for members around healthcare compliance issues and program integrity. Respond to member queries on these issues.
  10. Provide analysis of hospital financial and operational impact of proposed program or regulatory changes.
  11. Support the annual THA Compliance Conference by developing agenda topics and presentations, identifying guest speakers and assisting with logistics.
  12. Must have the ability to adapt to a changing work environment and meet challenges presented throughout the day.
  13. 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.

Position Requirements

Educational and Experience Requirements Needed to Perform the Duties of the Job:

Licensing or Other Special Certifications Required:

Healthcare compliance certification desired

Skills Required to Perform the Duties of the Job:


Application Instructions

Please submit your resume and apply here.

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