Vice President, Research & Reimbursement
Tennessee Hospital Association
Finance & Accounting , Health Care , Legal
Position Description / Responsibilities
Coordinates a network of hospital and health system reimbursement specialists and provides 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. Creates regular educational and professional development opportunities for member hospitals related to current and emerging topics in hospital reimbursement and compliance.
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.
- Provide in-depth research, support, education and advocacy for members around healthcare compliance issues and program integrity. Provide a statewide focal point for compliance education and compliance officers. Respond to member queries on these issues.
- Provide analysis of hospital financial and operational impact of proposed program or regulatory changes.
- 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.
- Provide a forum for addressing members’ issues with payers and represent THA members around common administrative issues. Work with hospitals to identify, research and then negotiate solutions to or mitigate impact of common issues that hospitals encounter with payers (commercial, Medicaid or Medicare Advantage).
- Communicate regularly with hospital members around current developments impacting reimbursement, providing education on changes as well as receiving input on their concerns.
- Evaluate and provide feedback on payer proposals and plans to implement changes in payment methodology; educate members about the potential impact.
- Provide input and make recommendations into the development of TennCare policy and reimbursement issues. Provide education and advocacy around transitions and programmatic changes within the TennCare program as well as TennCare operational issues/reimbursement methodologies, benefit changes and rule and waiver changes.
- As needed, work with the TennCare Oversight Division of the Tennessee Department of Commerce & Insurance to address issues and concerns regarding the TennCare Managed Care Organizations (MCOs).
- 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, and participate in advocacy efforts.
- Monitor changes in the Medicare Advantage program.
- 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.
- Plan, execute and host multi-state managed care conference in rotation.
- Provide in-depth research and education and develop presentations on current topics in healthcare compliance.
- Monitor and research proposed governmental program changes and make recommendations based on knowledge of their impact on hospital operations.
- Provide education (and networking forums) for those responsible for compliance and program integrity in hospitals and develop/make presentations on current topics in healthcare compliance. Plan, execute and host annual statewide compliance conference.
- Work with healthcare fraud enforcement agencies (including US Attorney offices, Medicaid program integrity and CMS Office of Inspector General) to keep lines of communication open and to provide current information to members.
Educational and Experience Requirements Needed to Perform the Duties of the Job:
- Educational requirement:
- Minimum of ten years’ experience in health care required. Background experience and knowledge should include:
- Experience with the following:
Bachelor’s degree in accounting, finance or other related field required. Graduate degree in related field preferred.
-Detailed knowledge of hospital managed care—commercial, Medicare, Medicaid and workers’ compensation, including:
Investigation and resolution of payment errors
Measuring contract performance
-Hospital & system operations experience desired
-General knowledge of the following as it relates to hospitals:
Billing and collections
Health information management
Quality & accrediting bodies
Managing reimbursement analysis/negotiation
Operationalizing financial arrangements
Identifying and resolving issues involving reimbursement, hospital operations and healthcare compliance
Building and managing relationships with managed care payers/outside entities
Licensing or Other Special Certifications Required:
Healthcare compliance certification desired
Skills Required to Perform the Duties of the Job:
- In-depth 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 use good judgment as to whether problems actually exist or need to be escalated.
- Must have strong problem-solving skills and be able to find solutions through detailed research, strategic thinking and effective communication.
- Ability to understand both sides of a dispute and move toward resolution/mitigation of issue.
- Ability to work constructively with payers and maintain positive working relationships while advocating for hospital members.
- Must have excellent written and verbal communication skills.
- Must have excellent presentation skills.
- Must have the ability to take complex issues and explain them in an appropriate manner based on the knowledge level of the audience.
Please submit your resume and apply here.