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ASSOC DIR, EXT REIMB RPRTNG,DUHS
Job Title: ASSOC DIR, EXT REIMB RPRTNG,DUHS
Job Code: 5118
FLSA: E
Job Level: I2
Revised Date: 12/01/2020
Supervisory Responsibility: No
General Description of the Job Class
Has primary responsibility for preparation of annual Medicare, Medicaid, Tricare and other external Cost Reports and submissions and ensures all reporting is in compliance with applicable codified governmental reporting principles and guidelines for Duke University Health System, Inc. (Home Office) and three Hospitals, an Ambulatory Surgery Center, Home Health, Home Infusion and Hospice. Oversees the data collection function for prospective, amended and re-opened Cost Reports and assists in the analysis of that data. Oversees all audit and desk review analysis and coordinates responses to auditor inquiries. As appropriate, initiates the re-opening process. Performs these functions in accordance with established Health System policy and procedure. Interacts closely with various Duke University Health System and Hospital entities to optimize governmental reimbursements in compliance with the governmental guidelines.
Duties and Responsibilities of this Level
Responsible for coordinating the timely submission of compliant governmental reporting including:
Annual Medicare, Medicaid and Tricare Cost Reports
Medicare, Medicaid, Tricare Appeals and Re-opened Cost Reports
Wage Index and Occupational Mix submissions
NC Supplemental DSH and Rate Eligibility
Audit and Desk Review responses
Responsible for the development and management of Cost Report compilation processes in a manner consistent with Health System strategies, policies and procedures including:
Management of all compilation software and analytical support systems to ensure compliant reporting.
Coordinate all system upgrades and ensure periodic updates are timely and appropriately installed and available for timely and compliant reporting.
Establish relationships with Health System and Hospital contacts to ensure appropriate communications and access to required source documentation.
Serve as the primary contact for annual compilation efforts.
Interact closely with Health System entities and contacts to ensure efficient access to required documentation and data and optimize Cost Report reimbursements.
Evaluation of new services, departments, activities and accounts for appropriate Cost Report consideration and ensure compliant presentation in annual reporting.
Support the development of the support systems and processes for compliant periodic, annual governmental and ad hoc reporting.
Oversee and coordinate the development and submission of clear, concise and complete responses to audit inquiries and request for documentation
Coordinate and support the analysis and development of documentation necessary to support Third-Party settlement accounts including revenue deductions, contractual allowances, settlement account estimates and other reserves.
Identify and recommend appropriate changes in compilation procedures and systems that will ensure appropriate and compliant reporting.
Monitor and maintain trend analysis in support of annual and periodic management reporting.
Responsible for the specific development, coordination and support of compliant reporting for:
Interns & Resident FTEs (IRIS)
Organ Acquisition
Revenue and Usage documentation
Settlement and Payment Data
Core Workpapers
Supplemental support and documentation
Active role in supporting the Director and Senior Director Reimbursement in developing the strategies, policies and procedures for Health System Reimbursement including:
Serving as a liaison to Health System and Hospital entities and external organizations.
Interacting with all Health System entities in the development and implementation of analytics and support activities for Cost Report compilation.
Maintaining and updating internal policy and procedure documentation.
Responsible for maintaining knowledge of support system operations, federal and state guidelines, ensuring Reimbursement Staff is similarly knowledgeable of and preparing required supporting compilation documentation in compliance with applicable laws and guidelines.
Represent positively Health System Reimbursement to external audiences at conferences, presentations, workshops, association meetings, etc.
Represent Health System Reimbursement in day-to-day reimbursement and Cost Report activities and develop positive working relationships with appropriate entity contacts.
Perform other assigned responsibilities and projects as delegated by the Director Reimbursement and Senior Director Reimbursement and Vice President for Revenue and Payer Finance.
Develop and implement personal development opportunities to ensure continuing professional growth for Reimbursement Staff.
This position will communicate directly with the Director and Senior Director Reimbursement and Vice President for Revenue and Payer Finance as well as the Health System Controller, Hospital CFO and PRMO Senior Management and Revenue Managers.
Required Qualifications at this Level
Education
Work requires a Bachelor's degree in Accounting, Finance, Economics, Business Administration or a related field.
Experience
Work requires a minimum of eight years experience in financial management, cost accounting or a field directly related to specialized area of assignment.
OR AN EQUIVALENT COMBINATION OF RELEVANT EDUCATION AND/OR EXPERIENCE
Degrees, Licensure, and/or Certification
N/A
Knowledge, Skills, and Abilities
N/A
Distinguishing Characteristics of this Level
N/A
The intent of this job description is to provide a representative and level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a declaration of the total of the specific duties and responsibilities of any particular position. Employees may be directed to perform job-related tasks other than those specifically presented in this description.
Duke University is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.
Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas-an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.
Essential Physical Job Functions
Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.
