Job Description

Job Title: Director, Corporate Reimbursement
Job ID: 180000O1
Status: Full-Time
Regular/Temporary: Management
Hours: Daylight, Monday thru Friday
Shift: Day Job
Facility:
Department: Reimbursement
Location: 600 Grant St, Pittsburgh PA 15219

Description

Are you an experienced hospital finance professional with a passion for strategic reimbursement protocol? Do you have a decorated career working in a multi-site academic medical center? Are you an effective leader and communicator and enjoy managing a team? Consider this rare opening at one of the eastern US' fastest growing health systems!

A world-renowned health care provider and insurer, Pittsburgh-based UPMC is inventing new models of accountable, cost-effective, patient-centered care. It provides more than $900 million a year in benefits to its communities, including more care to the region’s most vulnerable citizens than any other health care institution. As Pennsylvania’s largest nongovernmental employer, with more than 80,000 employees, UPMC is comprised of more than 35 hospitals, more than 600 doctors' offices and outpatient sites, an international division, and an enterprises division.

The Corporate Finance division at UPMC seeks a full-time Director of Corporate Reimbursement to lead our hospital reimbursement strategy and technical initiatives. Based in Pittsburgh, PA, this role will be tasked with a variety of initiatives including cost reporting filing, disproportionate share calculating, optimizing residency programs, and ensuring 340B qualifications.

As Director, you will work in conjunction with the CFO, UPMC Hospital Network to direct the governmental and third party hospital reimbursement activities of all specifically designated System entities, including but not limited to UPMC Presbyterian Shadyside, UPMC St Margaret, UPMC McKeesport, UPMC Mercy, UPMC Hamot, UPMC Passavant, UPMC Horizon, UPMC Kane, UPMC Bedford, Magee-Womens Hospital of UPMC, UPMC Northwest, UPMC Altoona, UPMC East, UPMC Jameson and Children's Hospital of Pittsburgh of UPMC which approximates $800 million to $1 billion in Medicare and Medicaid revenue annually. Additionally, you will have oversight for and evaluation of integrations with recently acquired UPMC Chautauqua at WCA located in New York state, multi-site UPMC Susquehanna, and multi-site UPMC Pinnacle located in central/southeastern Pennsylvania.

As Director, you will direct, control, and administer all personnel management functions for the Reimbursement Department, including but not limited to, interviewing, recruiting, hiring, training, performance appraisals, disciplinary/corrective action, scheduling, departmental policies and procedure development and other areas of staff development.

A highly visible role, this position reports directly to the CFO of the UPMC Hospital Network and will work closely with other senior financial management leaders at the corporate level.

Think you're up for this incredible challenge? Apply today!

Responsibilities:
  • Develops and/or directs the timely preparation, accuracy and integrity of year-end third party cost reports for those facilities serviced.
  • Develops educational routes as well as training the staff in third-party reimbursement principles and compliance regulations to enhance the staffs professional growth and knowledge of global healthcare, financial and industry issues.
  • Directs and develops a staff of professional and clerical personnel. Directs day-to-day routine and non-routine departmental reimbursement activities.
  • Directs and oversees the preparation of third party interim rates, including the distribution of those rates to the applicable internal departments. * Directs the preparation of the resident affiliation agreement to ensure the accuracy of the System Medicare Indirect Medicare Education and Direct Medical Education residency caps and resulting resident affiliation cap agreement. * Directs, researches, evaluates, interprets and enforces all government and third party payer contracts. *
  • Directs delegating the workload to reimbursement personnel staff and is responsible for training and instruction needed to complete their assignments.
  • Directs the activities of all third party auditors including, but not limited to, audit exit conferences, including reviewing, researching and recommending alternatives to third party audit adjustments, initiating re-openings for finalized cost reports if necessary to ensure compliance with the Medicare regulations and optimization of Medicare reimbursement.
  • Directs the integration, restructuring and support for the Reimbursement department, establishing a supporting Regulatory function, a supporting ISD function, and a centralized and standardized Reimbursement reporting structure, within the parameters approved by upper management. * Other responsibilities include directing the organization and maintenance of work papers and files in a concise and orderly manner, and occasional travel to hospital sites and administrative offices as applicable for specified facilities. *
  • Directs the research and accumulation of data for filing of formal appeals, exception requests to rates or payment methodologies to support the Hospitals position on governmental and third party regulations. * Directs, implements, and performs financial analysis of new services, new programs and special projects as they arise. * Directs the preparation and oversees the accuracy and integrity of year-end CRA calculations, implementing and testing the soundness of the CRA model, ensuring that System providers are reporting proper and accurate data on a monthly basis.
  • Directs, controls, and enforces the timely and accurate submission, accumulation and maintenance of all supporting information relating to the cost reports from individuals in various departments throughout the UPMC organization and outside sources such as, but not limited to, insurance companies, government intermediaries, vendors, independent consultants, government agencies, and hospital groups, including statistics, time allocation reports, third party logs, reclassifications, adjustments and settlement (payment) data.
  • Directs, investigates and implements potential revenue enhancement opportunities to optimize hospital reimbursement, including but not limited to Medicare outliers, Medicare wage index, Disproportionate Share, Indirect and Direct Medical Education payments, Organ Transplantation, Medicare Bad Debts, and Medicaid Tobacco Funds, . * Manages Reimbursement departmental budget. * Directs the implementation of Reimbursement standardized reporting for all UPMC facilities, including but not limited to the CRA summary model, resident counts, bed counts, disproportionate share days, Medicare bad debts, wage index, managed Medicare days, observation bed days, Medicare outliers, and physician time studies.
  • Directs, researches, evaluates, interprets and enforces all government and third party payer regulations, offering comments to proposed Medicare regulations that impact Medicare payments for all System providers. Directs, researches, evaluates, interprets Proposed and Final Medicare regulations, including special regulatory provisions to ensure compliance with Medicare regulations and optimization of Medicare reimbursement, and any new Medicaid reimbursement methodologies including but not limited to the Ma Modernization model including the Medicaid supplemental payments and the interaction with the Medicaid Disproportionate Share Upper Payment Limitation.
  • Strategizes and implements recruitment efforts and training new personnel as well as evaluates personnel under incumbents management, including corrective/disciplinary action when necessary.

Qualifications

  • College degree in Accounting/Finance.
  • 8 to 10 years of previous experience in an environment of progressively increasing amounts of responsibility in a health care industry.
  • Previous experience working for a multiple facility health care system or Medicare Fiscal Intermediary preferred.
  • CPA, Masters Degree or equivalent preferred.
  • Extensive knowledge of third party regulations, reimbursement practices and health care accounting.
  • Supervisory experience is needed in a reimbursement or hospital finance setting.
  • Must have superior interpersonal, written and oral communication skills. 
  • Must possess excellent planning, analytical and creative thinking skills, and also possess good decision making skills.
  • Must be able to handle confidential material and develop and motivate department personnel, fostering an atmosphere of dignity and respect.
UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $0 to $0

Union Position: NA

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

QUALITY & SAFETY
DIGNITY & RESPECT
CARING & LISTENING
RESPONSIBILITY & INTEGRITY
EXCELLENCE & INNOVATION

UPMC provides a total rewards package that can help you achieve the goals you have for your career and your personal life. Whether you want to learn a new skill through a training course, reach personal health and wellness targets, become more involved in your community, or follow a career path that provides you with the right experience to be successful, UPMC can help you get to where you want to be.



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