Vice President, Finance & Medicare

Tennessee Hospital Association

Brentwood, TN

Community & Nonprofit


Position Description / Responsibilities

JOB SUMMARY:   

Responsible for the implementation of the THA initiatives on financial issues including, but not limited to, government payer reimbursement issues including traditional Medicare, TennCare, and health reform. The position serves as a member resource on issues including capital funding and investments, cost accounting, financial reporting and budgeting. 

The position is responsible for providing financial consultation to THA Legal Counsel. 

This position assists in legislative advocacy efforts by providing support to the Government Affairs Department on appropriate financial issues, including hospital charging, billing and collections. The individual in this position monitors state and federal reimbursement issues and communicates emerging issues and recommendations to the THA Board, staff and membership. The VP of Finance & Medicare ensures the statewide hospital charge transparency website remains current. 

The position coordinates with and provides financial consultation to the THA SVP of the Tennessee Center for Patient Safety (TCPS) and the membership on the financial impact of quality reporting and pay for performance issues. 

The position provides financial consultation and coordinates with the SVP of THA Solutions Group (THASG) in the evaluation and selection of potential vendors to service THA membership. 

This position assists with the development of corporate and division goals on financial, reimbursement and federal program integrity issues and the development of programs, education and other operations to insure effective accomplishment of the association’s goals. 

The position is responsible for coordination with outside legal counsel, consultants and members for group member appeals on reimbursement issues. 

The position serves as THA’s primary membership resource for Emergency Medical Treatment and Labor Act (EMTALA) reimbursement guidelines and requirements and tax-exempt hospital IRS 990 guidelines and requirements.

ESSENTIAL FUNCTIONS OF THE JOB

  1. The ability to adapt to a changing work environment and meet challenges presented throughout the day.
  2. Provide vision, leadership and administrative oversight for the strategic planning and implementation of certain hospital finance and reimbursement initiatives by THA.
  3. Serve as the primary member contact for traditional Medicare regulatory issues including reimbursement, cost reporting, IRS-990, financial ethics and program integrity issues.
  4. Act as a staff resource for reimbursement task forces and committees and in development of the THA advocacy agenda. This includes preparing financial models and/or research to evaluate THA’s legislative or regulatory policy position.
  5. Provide the membership information on certain developments in healthcare finance at the national and state levels. Evaluate those developments and provide membership direction in assessing the impact of those developments on their respective organizations.
  6. Has a working knowledge of the following Medicare reimbursement systems in order to make strategic recommendations for maximizing program benefits under:
    1. the Medicare Inpatient Prospective Payment System
    2. the Medicare Outpatient Prospective Payment System
    3. the Medicare Long Term Care Hospital (LTCH) Prospective Payment System
    4. the Home Health Prospective Payment System
    5. the Inpatient Rehabilitation Facility Prospective Payment System
    6. the Skilled Nursing Facility (SNF) Prospective Payment System
    7. the Inpatient Psychiatric Facility Prospective Payment System
    8. the Critical Access Hospital (CAH) cost payment system
    9. the physician fee payment system
  7. Identify, develop and provide recommendations for changes in federal and state laws to enhance hospital reimbursement or relieve hospital regulatory burdens.
  8. Provide written responses and commentary to state and federal regulatory agencies including the Centers for Medicare and Medicaid Services (CMS), the Internal Revenue Service (IRS) and others on proposed rules and regulations.
  9. Analysis of risk-based programs with strong orientation to actuarial soundness.
  10. Assist hospitals in addressing employer demands for cost control.
  11. Assist membership on issues of patient access, patient accounting, chargemaster, billing, charity policies, and discounts to the uninsured.
  12. Development and ongoing enhancements of the hospital price transparency initiative.
  13. Development of education programs, website and other resources to support members on certain financial initiatives.
  14. Develop regular updates and communication to membership on hospital finance and reimbursement issues.
  15. Assist in strategic planning of THA and key departments, THASG and THERF to achieve maximum membership satisfaction and maintain proactive positions on issues.
  16. Maintain a positive relationship with external agencies and governmental entities including the CMS national and regional offices, the Medicare Administrative Contractors (MACs), and Recovery Audit Contractors (RACs).
  17. Timely supervision and completion of special assignments by the President and EVP/COO.
  18. Participate in:
    1. THA Reimbursement Committee
    2. American Hospital Association - Medicare/Medicaid Policy and Finance sections
  19. Stay abreast of dynamic regulatory changes for traditional Medicare.
  20. Develop THA’s response to numerous financial and reimbursement issues.
  21. Must be available for out of town travel approximately 5 percent of the time, be able to drive an automobile and maintain a valid driver’s license.
  22. Must be available in the office during regular office hours.
  23. The ability to sit for long periods of time. 

MARGINAL JOB FUNCTIONS

1.   Serve as staff liaison to the Chattanooga Hospital District. 


Position Requirements

SKILLS REQUIRED TO PERFORM THE DUTIES OF THE JOB:

  1. The ability to develop revenue maximization strategies which are fiscally responsible at the federal and state level.

  2. The ability to determine and prioritize the impact of many complex reimbursement issues and provide evaluations in understandable formats.

  3. The position requires independent judgment and organizational and planning skills to prioritize and develop initiatives and programs to meet determined needs.

  4. The ability to determine whether a proposed rule, regulation or law is of concern to THA members, whether it accomplishes a worthwhile objective and whether it is unduly burdensome.

  5. The ability to evaluate the expectations and needs of the THA membership and whether they can be met best through education, THA staff consulting services or THASG vendor consulting services.

  6. A strong working knowledge of:

    1. the financial operations of healthcare institutions

    2. the law, rules and regulations related to the Medicare program

    3. Medicare inpatient Medicare Severity Diagnosis Related Group (MS-DRG) assignment and payment methodology

    4. Medicare outpatient Ambulatory Payment Classification (APC) assignment and payment methodology

    5. modeling and pricing analysis for managed care contracts

    6. financial data analysis

    7. accounting standards for healthcare organizations

    8. auditing standards and guidelines for healthcare organizations

    9. healthcare internal audit functions and responsibilities

    10. general billing practices and procedures

    11. healthcare cost accounting

    12. the Medicare Cost Reports

    13. the Tennessee Joint Annual Report for Hospitals

  7. Knowledge of and ability to interpret:

    1. Federal and state hospital reimbursement laws and regulations

    2. Patient billing and use of standardized UB-04 billing form and fields

    3. Health maintenance organization financial reports including incurred but not reported calculations (IBNR)

    4. Hospital financial statements

    5. Hospital Medicare and other payer contractual calculations

    6. Medicare cost reports

    7. Annual reports to the state (Joint Annual Report of Hospitals)

    8. Hospital medical record coding (ICD 10, CPT4 coding)

  8. The ability to make effective presentations before large groups.

  9. The ability to maintain good working relationships with membership and state and federal regulators.

  10. Excellent communication skills, both oral and written.

  11. Extensive computer skills, including Microsoft Word, Excel, CRM, PowerPoint, and Outlook. 

EDUCATIONAL AND EXPERIENCE REQUIREMENTS NEEDED TO PERFORM THE DUTIES OF THE JOB:

Requires either:   

At least five years of experience in a related position in a hospital or health system as well as a Master’s in Business Administration (MBA) or a related field or Certified Public Accountant (CPA) 

or

At least ten years of experience in a related position in a hospital or health system and a Bachelor’s in Business Administration (BBA) or a related field, with CPA preferred.   

LICENSING OR OTHER SPECIAL CERTIFICATIONS REQUIRED:

Depending on the experience level, a CPA may be required—see preceding section.


Application Instructions

Please send your resume along with a cover letter by:

email to scrutchfield@tha.com;

fax to 615-242-8327;

or mail to:

Suzette Crutchfield

Tennessee Hospital Association

5201 Virginia Way

Brentwood, TN 37027 

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