Vanderbilt Univ Medical Center - Nashville, TN

posted 4 months ago

Full-time - Mid Level
Remote - Nashville, TN

About the position

The primary purpose of this position is to lead the most advanced analysis of strategic and financial matters related to Revenue and Reimbursement Strategy at Vanderbilt University Medical Center (VUMC). This role is crucial in managing projects that involve both hospital and professional business, requiring interaction with all levels of institutional personnel. The candidate will need a robust technical knowledge base that includes hospital and/or professional financial analysis, third-party reimbursement, federal and state mandatory reporting, and gross and net revenue compilation, including contractual allowance and deduction modeling. The position also emphasizes reimbursement analytics, which is essential for the financial health of the institution. In the Reimbursement Strategy domain, the individual will provide recommendations and leadership for operational and strategic changes that support federal, state, or other third-party reimbursement initiatives. This includes leading or supporting the design and operational implementation of reimbursement-focused projects and procedures across the institution. The candidate will be responsible for recommending changes in operating practices, data collection, and information systems structures that will yield reimbursement benefits through data analysis and regulatory changes. Additionally, the role involves managing the production work related to various regulatory reporting, such as the Tennessee Joint Annual Report and IRS Form 990 Schedule H, and serving in roles such as preparer, coordinator, or reviewer. The position also requires managing the production aspects of Medicare and state reimbursement, including completing mandatory reporting and defending the hospital's position during audits. The candidate will need to provide support to the State Financial Reporting Department and operationalize changes in practices and data collection that result in reimbursement benefits. Furthermore, the role involves compiling, analyzing, and reviewing data for financial reporting of gross and net revenues, budgeting, forecasting, and monthly close processes. In terms of reimbursement analytics, the candidate will lead extensive qualitative and quantitative analyses, including revenue/reimbursement analysis, financial analysis, cost analysis, and market analysis related to patient care reimbursement. The role requires proficiency in hospital/professional financial and patient care decision support database tools, as well as the ability to design complex SQL queries and perform data extraction over large datasets. The candidate will also be responsible for project leadership and management, providing simultaneous leadership on multiple projects, educating leaders and physicians on reimbursement matters, and supervising the work of employees assisting with these tasks.

Responsibilities

  • Provide recommendations and leadership for operational/strategic changes in support of Federal/State or other third-party reimbursement initiatives.
  • Lead or support the design and operational implementation of reimbursement-focused projects/procedures across the institution.
  • Recommend 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.
  • Lead/Assist 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.
  • Identify reimbursement opportunities by reviewing past regulatory reporting for strategic opportunities.
  • Remain abreast of new regulatory and/or requirement changes and provide advice on compliance.
  • Provide support for compliance-related matters impacting the organization where applicable to reimbursement.
  • Assist colleagues in developing and submitting sensitive information to government officials.
  • Champion important initiatives with sometimes difficult constituencies.
  • Perform pro forma modeling and retrospective analyses to increase reimbursement.
  • Develop strong relationships with clinical areas acting as a consultant regarding revenue/reimbursement matters.
  • Serve as a consultant to the reimbursement production team on reimbursement matters.
  • Manage production aspects of Medicare & State reimbursement including completing mandatory State and/or Federal reporting.
  • Defend the hospital's position on all audits of mandatory Federal and State reporting and other billing audits.
  • Provide support to the State Financial Reporting Department for the completion of the Federal Indirect Cost proposal.
  • Compile, analyze and review data for financial reporting of gross & net revenues for budgeting, forecasting, and monthly close.
  • Calculate monthly realization/deduction rates and apply them to current financial projects.
  • Supervise, coordinate and defend complex regulatory audit inquiries; develop methods for managing and controlling communications with external audit teams.
  • Lead extensive qualitative and quantitative analyses including revenue/reimbursement analysis, financial analysis, cost analysis, and market analysis related to patient care reimbursement.
  • Provide simultaneous leadership on multiple projects and areas of expertise, including project management of assigned projects and organizing team activities.

Requirements

  • 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.
  • 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.

Nice-to-haves

  • 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.

Benefits

  • Professional growth opportunities
  • Comprehensive health insurance
  • Retirement savings plan
  • Paid time off
  • Diversity and inclusion programs
  • Employee wellness programs
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