Senior Director of Reimbursement Revenue Advisory Services

General Summary

The Senior Director of Reimbursement is responsible for the reimbursement function of the University of Maryland Medical System, including the University of Maryland Medical Center, Baltimore Washington Medical Center, Maryland General Hospital, Shore Health System, James Lawrence Kernan Hospital, Chester River Hospital Center and University Specialty Hospital. The position provides strategic rate setting and revenue advisory services to System Chief Financial Officers (CFOs), and is responsible for directing the directors and managers overseeing financial reimbursement analyses, charge capture and charge master procedures and HSCRC and CMS regulatory reporting. 

The Senior Director is also responsible for the establishment of goals, objectives, and standards of performance; development and implementation of operating policies and procedures; interpretation and insurance of compliance with relevant policies and procedures, standards, regulations and codes to personnel.

Principal Responsibilities and Tasks

The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification.  They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

1. 1. Directs the operations of the department while applying hospital policies and procedures as well as federal, state, and local statues or regulations governing general financial practices to insure accurate and effective service.
   2. Provides reimbursement and revenue strategic advisory services to System CFOs:
      1. Makes recommendations to improve current HSCRC reimbursement and develops new reimbursement strategies to maximize reimbursement.
      2. Provides analysis and insight into HSCRC reimbursement methodologies.
      3. Educates management on reimbursement topics and issues.
      4. Negotiates with the HSCRC to implement new UMMS and statewide reimbursement policies and methodologies.
      5. Primary liaison with the HSCRC and CMS on methodology issues.
      6.  Negotiates annual rate and charge per case adjustments with the HSCRC to ensure maximum HSCRC approved revenue.
2. 1. Directs the operations of the reimbursement function for all System hospitals:
3. 1. 1. Ensures hospital pricing achieves maximum revenue allowed while ensuring compliance to all federal and state billing regulations.
      2. Analyzes and reports monthly financial statement revenues for each facility.
      3. Develops annual revenue budgets and the revenue assumptions for the five year strategic plan.
      4. Ensures accurate and timely preparation of all state and federal mandated regulatory disclosures.
      5. Directs the analysis and reporting of the inpatient and outpatient case-mix issues related to rate-setting methodologies of the HSCRC.
4. 1. Directs the operations of the charge capture and charge master function  UMMC, JLK and USH:
      1. Ensures the charge master complies with federal and state billing and regulatory requirements.
      2. Communicates with clinical departments to ensure compliance to charge capture policies and procedures.
      3. Monitors clinical departments’ charge practices and volume levels.
      4. Oversees monthly reporting of revenue and statistics both internally and externally.
5. 1. Directs a staff of directors, managers and reimbursement analysts in accordance with departmental and UMMS personnel policies and procedures.
      1. Performs individual performance evaluations and recommends and/or initiates disciplinary actions, as needed.  Establishes clear and concise work procedures and expectations, assessing performance levels by monitoring results and providing positive.
      2. Assures timely and accurate completion of work by monitoring daily work activities.
      3. Trains staff on new practices and promotes staff professional development.
6. 1. Communicates regularly with other finance directors to ensure optimal efficiency and effectiveness of financial reporting.
   2. Keeps abreast of current regulatory (HSCRC & CMS) information/guidelines; communicates relevant changes and/or protocol and procedural revisions to senior management and staff.  Implements appropriate departmental operational changes to ensure compliance.
   3. Attends and participates in in-service training and various educational programs for professional growth and development.  Keeps up-to-date on changes in the hospital finance field.
   4. Performs related duties as required.