Director Reimbursement Analytics

Supports the Vice President, Reimbursement in all matters related to third-party accounting within the AAH service area. In addition, this position is to serve as a key liaison between the Reimbursement department and hospital financial leadership as well as governmental auditors and will be looked to as a departmental leader in technical issues related to the monthly financial close. Monitors proposed and final government reimbursement regulations and provides oversight in the development of the financial analysis around government and commercial reimbursement to determine the overall impact the changes have on the organization. Proposes changes to strategies to address the changes in reimbursement in order to maximize AAH’s reimbursement.

• Oversees the completion of required monthly financial analyses for AAH hospitals to support the net revenue calculation and other reporting needs. This includes coordination and management of staff responsible for the calculation of the monthly financial statement calculations related to third-party reimbursement matters and ensuring consistency amongst all the AAH hospitals’ calculations and source data utilized.
• Manages and maintains appropriate external relationships with the Fiscal Intermediary, IDPA, WDPA, Illinois/Wisconsin Hospital Associations and consultants engaged on behalf of Advocate Aurora as well as internal relationships with the Medical Education Department, SRCO, Payroll and General Accounting.
• Assists departmental leadership with the valuation of required Medicare cost report reserves and Valuation Allowance accounts and assists in supporting the calculation with external financial auditors during year-end audit. 
• Acts as AAH’s finance representative in regards to matters which relate to third party reimbursement. This can include but is not limited to participating on State Hospital Association and State Medicaid task forces and internal councils, teams, panels, educational projects and steering committees.
• Identify, research, and initiate opportunities to enhance revenue and improve administrative efficiency of governmental payer programs while ensuring internal Advocate Aurora policies are updated and all staff are aware of and following the applicable policy points.
• Assists in the development and forecasting of systemwide revenue budgets. Ensures that budgeting for Gross and Net Patient Revenue is accurate, timely, and complies with accounting standards. Working with members from the revenue cycle and managed care operations, leads the analysis of budget variances on a monthly basis, including the preparation of the necessary analysis to document and explain the budget variance to leadership and finance.
• Identify, research, and initiate opportunities to enhance revenue and improve administrative efficiency of governmental payer programs while ensuring internal Advocate Aurora policies are updated and all staff are aware of and following the applicable policy points.
• Remains up to date on reimbursement matters impacting the calculation of AAH net patient revenue and be able to disseminate such information to the team in a clear and timely manner to allow consistent and correct calculations to be performed including issues related to FASB Revenue Recognition pronouncements.
• Assists in the development of annual departmental budgets, monitors monthly performance to budget, and when necessary initiates actions to rectify variances.

Scheduled Hours

Corporate business hours.  This position is primarily remote; willing to consider out of state candidates.

Licenses & Certifications

None Required.

Degrees

Bachelor's Degree in Accounting, or

Bachelor's Degree in Finance or related field.

Required Functional Experience

Typically requires 7 years of experience in health care reimbursement or public accounting with a concentration in hospital auditing that includes extensive auditing of the hospital net patient service revenue area, Medicare, Medicaid, or Blue Cross.

Required Management Experience

Includes 3 years of management experience in managing staff and budgets.

Knowledge, Skills & Abilities

Ability to use Microsoft Office programs. Ability to use Medicare/Medicaid cost reporting software.  Ability to use AAH’s general ledger, accounts payable, payroll, patient accounting, and decision support systems. Must possess strong analytical and accounting skills. Must possess detailed knowledge of various reimbursement methodologies such as DRG, per-diem, capitation and percent of charges. Must possess detailed knowledge of Medicare and Medicaid reimbursement rules as well as a detailed understanding of the Illinois Blue Cross UPP system and Graduate Medical Education, Disproportionate Care, Transplant programs, and 340B issues.  Must possess the ability to work independently and under stressful conditions. Must be able to work weekends during peak cost reporting times, budget season and during year-end audit.  Must possess strong communication and interpersonal skills and the ability to communicate revenue cycle issues to all levels of the organization.