The primary purpose of this position is to lead the most advanced analysis of strategic and financial matters related to Revenue and Reimbursement Strategy. This role will be responsible for projects which involve both hospital and professional business and will interact with all levels of institutional personnel. Technical knowledge base should include:
Hospital and /or professional financial analysis and third party reimbursement
Federal & State Mandatory reporting
Gross and net revenue compilation (contractual allowance/deduction modeling)
Key Functions and Expected Performances:
Provides recommendations and leadership for operational/strategic changes in support of Federal / State or other third party reimbursement initiatives.
Leads or supports in the design and operational implementation of reimbursement focused projects/procedures across the institution, including providing technical reimbursement expertise, analytics and project management/facilitation.
Recommends changes in operating practices, data collection, and information systems structures that will result in a reimbursement benefit through analysis of data and changes in regulations.
Leads/Assists with production work relating to the filing of various regulatory reporting such as the Tennessee Joint Annual Report, IRS Form 990 Schedule H or specific components of the annual Medicare cost report. Can serve in the roles of preparer, coordinator or reviewer.
Identifies reimbursement opportunities by reviewing past regulatory reporting for strategic opportunities.
Remains abreast of new regulatory and/or requirement changes and provides advice on complying with a constantly changing environment.
Provides support for compliance related matters impacting the organization where applicable to reimbursement.
Assist colleagues in developing and submitting sensitive information to government officials.
Champions important initiatives with sometimes difficult constituencies.
Performs pro forma modeling and retrospective analyses to increase reimbursement.
Develops strong relationships with clinical areas acting as a consultant regarding revenue/reimbursement matters.
Serves as a consultant to the reimbursement production team on reimbursement matters.
Performs special projects as assigned.
Federal & State Reporting and Defense
Manages production aspects of Medicare & State reimbursement including completing mandatory State and /or Federal reporting (Medicare Cost report, Tennessee Joint Annual Report (JAR), Medicaid Disproportionate Share Hospital (DSH) are examples)
Defends the hospital's position of all audit of mandatory Federal and State reporting and other billing audits. Reviews all audit adjustments for propriety. Prepares recommendations for improvements as a result of the audits to other operating areas for disposition.
Provides support to the State Financial Reporting Department for the completion of the Federal Indirect Cost proposal thus, a working knowledge of the OASC3- "Guide for Hospitals - -Cost Principles and Procedures for Establishing Indirect Cost and Patient Care Rates for Grants and Contracts" is needed. Remains abreast of new regulatory and/or requirement changes.
Operationalizes into production all changes in operating practices, data collection, and information systems structures that will result in a reimbursement benefit through analysis of data and changes in regulations.
Coordinates implementation of strategic initiatives into production.
Performs special projects as assigned.
Gross and Net Revenue: budgeting / forecasting / monthly close
Compiles, analyzes and reviews data for financial reporting of gross & net revenues for budgeting, forecasting and monthly close.
Calculates monthly realization/deduction rates and applies them to the current financial projects.
Interprets and translates current and foreseeable business changes into recommendations and overall estimated impacts to current and future net revenue utilizing the best information available to predict and calculate potential impacts to gross and net revenue.
Supervises, coordinates and defends complex regulatory audit inquiries; develops methods for managing and controlling communications with external audit team; develops methods for reporting audit findings to management; develop and present recommendations management regarding future corrective actions needed to facilitate compliance.
Monitor and review regulatory changes impacting accounting procedures; coordinate and design. materials/forums to communicate and educate the Vanderbilt community regarding regulatory changes.
Maximizes, monitors and reports predicted reimbursement/net revenues at the business unit level.
Initiate appropriate levels of review within the business unit to ensure maintenance of adequate levels of internal control.
Uses comprehensive knowledge of the role and goals of Vanderbilt departments, with an understanding of academic and healthcare accounting in accordance with generally accepted accounting principles (GAAP), applicable regulations, and Vanderbilt University Medical Center policies and procedures.
Performs special projects as assigned.
Leads extensive qualitative and quantitative analyses including revenue/reimbursement analysis, financial analysis, cost analysis, contract performance analysis, cost/benefits analysis, market analysis, and organizational analysis related to patient care reimbursement.
Creates structured analytical approaches to unstructured questions or problems, adding one's own insight in an ad hoc, interactive, analytical process. Work will be lead or performed at a variety of levels including: patient, program, payor, clinic, disease-site, point of entry, and others. Requires knowledge of clinical operations, billing, and coding.
Researches and analyzes outcomes at the patient detail level using available systems for hospital and professional services including the electronic health record.
Demonstrates proficiency in the hospital/professional financial and patient care decision support database tools. Analyzes and interprets data from these databases and provides information to management.
Designs and/or writes complex SQL (structured query language) queries in a variety of decision support systems or a data warehouse.
Provides direction and/or performs data extraction over large collections of data. Consolidates, summarizes, or transforms transaction data to support analytical reporting and trend analysis.
Reviews and analyzes reconciliations and resolves discrepancies between the patient accounting system and the various decision support systems.
Assists with the compilation of various regulatory reporting. Examples include the Tennessee Joint Annual Report, IRS Form 990 Schedule H or specific components of the annual Medicare Cost Report.
Evaluates operational and programmatic needs and identifies appropriate data analysis approaches and technologies to meet those needs.
Develops tools for use in evaluating strategic decisions based on operations and/or product line information.
Performs special projects as assigned.
Project Leadership/Management & Customer Service:
Provides simultaneous leadership on multiple projects and areas of expertise, including project management of assigned projects and organizing team activities.
Establishes appropriate mechanisms and goals to monitor project time lines and reporting to appropriate parties. Assess achievement of agreed upon project goals and communicate results. Make modifications to program plans, as necessary to achieve desired goals.
Educates leaders and physicians on reimbursement matters, opportunities, and risks.
Supervises, plans, directs, coordinates, and evaluates the work product of employees who assist with any of the work described in the major subject matter areas detailed in the job description.
Interfaces and maintains appropriate service with customers including hospital management and physicians.
Presents findings as required to a variety of audiences using excellent written and oral communication skills to communicate results/impacts.
Thoroughly documents analysis work for consistency and reproducibility.
Develops and leads technical training/education of project team members and customers. Provides mentoring relating to specific areas of expertise as needed/requested.
Demonstrates sound judgment and good decision making skills.
Experience with gross and net revenue modeling, budgeting and forecasting
Experience with Medicare cost report filing
Experience with patient care level data analysis and reporting
Experience with business intelligence tools and Standard Query Language (SQL).
Knowledge of various processes associated with revenue cycle in a complex business environment. Examples include patient billing services, patient access services, pricing master and third party contracting knowledge
Experience with Microsoft office programs
Working knowledge of hospital or professional patient accounting systems
Ability to gather relevant information systematically and breakdown problems into simple components and make sound decisions
Ability to contribute innovative thinking and new ideas/solutions in a multidisciplinary team environment
Experience with Vanderbilt University Medical Center (VUMC)
Hands on experience with Business Objects, Medipac, EPIC, or Hyperion
Knowledge of third party contracting concepts
Familiarity with an Electronic Medical Record
Knowledge of cost accounting
Familiarity with charge description master
Knowledge of ICD CM and coding
Knowledge of current Federal and State regulations impacting reimbursement
Excellent presentation and communication skills
Education and Certifications
Masters degree or equivalent years of experience (preferred)
Highly recommended: Eight years of experience in Federal cost reporting, net / gross revenue support, or patient care level decision support analytics in a large healthcare environment, hospital, physician practice, third party payer, Medicare intermediary or accounting/consulting firm.
Preferred: Ten years of experience in Federal cost reporting, net / gross revenue support, or patient care level decision support analytics in a large healthcare environment, hospital, physician practice, third party payer, Medicare intermediary or accounting/consulting firm.
Vanderbilt University Medical Center is home to Vanderbilt University Hospital, The Monroe Carell Jr. Children’s Hospital at Vanderbilt, the Vanderbilt Psychiatric Hospital and the Vanderbilt Stallworth Rehabilitation Hospital. These hospitals experienced more than 61,000 inpatient admissions during fiscal year 2015. Vanderbilt’s adult and pediatric clinics treated nearly 2 million patients during this same period. Vanderbilt University Hospital and the Monroe Carell Jr. Children’s Hospital at Vanderbilt are recognized again this year by U.S. News & World Report’s Best Hospitals as among the nation’s best with 18 nationally ranked specialties. Vanderbilt University Medical Center is world renowned because of the innovation, work ethic and collegiality of its employees. From our health care advances to our compassionate care, Vanderbilt owes its accomplishments and reputation to staff and faculty who bring skill and drive and innovation to the medical center day after day. World-leading academic departments and comprehensive centers of excellence pursue scientific discoveries and transformational educational and clinical advances across the entire spectrum of health and disease.As t...he largest employer in middle Tennessee, we welcome those who are interested in ongoing development in a caring, culturally sensitive and professional atmosphere. Most of us spend so much of our lives at work, we want to be part of maintaining a workplace in which people support one another and encourage reaching for excellence. Many high-achieving employees stay at Vanderbilt because of the professional growth they experience and because of their appreciation of Vanderbilt’s benefits, public events and discussions, athletic opportunities, beautiful setting and, above all, sense of community and purpose.Vanderbilt and its employees share a set of mutual expectations that have been created with productivity, legality, fairness and safety always in mind. We believe that our investment in training and compensating employees multiplies in value when we enable individuals to deliver their best performance for the benefit of us all.
To improve the patient experience by providing health care providers; patients and their families; and others with information, education, networking opportunities, and related resources focused on best practices.