Director of Reimbursement

Are you looking for a career opportunity wokring for a healthcare organization that is based on excellence and love?

ChristianaCare is one of the country's most dynamic healthcare organizations, centered on improving health outcomes, making high-quality care more accessible, and lowering healthcare costs. ChristianaCare includes an extensive network of outpatient services, home health care, urgent care centers, three hospitals (1,299 beds), a free-standing emergency department, a Level I trauma center and a Level III neonatal intensive care unit, a comprehensive stroke center and regional centers of excellence in heart and vascular care, cancer care, and women's health. It also includes the pioneering Gene Editing Institute and was rated by IDG Computerworld as one of the nation's Best Places to Work in IT. ChristianaCare is a nonprofit teaching health system with more than 260 residents and fellows. It is continually ranked by U.S. News & World Report as the Best Hospital. With the unique CareVio data-powered care coordination service and a focus on population health and value-based care, ChristianaCare is shaping the future of health care.

ChristianaCare Offers

• Full Medical, Dental, Vision, Life Insurance, etc.
• Two retirement planning offerings, including 403(b) with company contributions
• Generous paid time off with annual roll-over and opportunities to cash out
• 12-week paid parental leave

About This Position

ChristianaCare is searching for a Director of Reimbursement to handle third-party cost reporting and reimbursement functions of the health system. Oversight of these functions and the direction of the related departmental staff will ensure third-party cost reports, filings to regulatory agencies and relevant questionnaires are completed in a compliant and timely manner. Related to these activities, the Director will also hold primary responsibility for inquiries from third-party auditors, government regulators and other outside agencies. Additionally, this position is responsible for performing and overseeing the reimbursement analyses necessary to support third-party reserves, performance of payer contracts, service line performance, and business plan development for the health system. This position will also have frequent interaction with Senior Leadership, will serve on system steers and workgroups to provide relevant financial expertise.

Primary Duties and Responsibilities

Provides oversight of the staff, processes, and procedures necessary to evaluate and maintain Medicare cost reports, third-party reimbursements, and other reports and questionnaires that are consistent with organizational goals and expectations.

Communicates directly with third-party insurers and auditors, and manage staff, to ensure the positive resolution of third-party audits and inquiries.

Provides for the analysis of regulatory changes and communicates the related impact to ChristianaCare to Finance and Executive Leadership.

Collaborates with Government Affairs and Patient Financial Services to address regulatory impacts internally and with outside governmental agencies.

Provides education to system leadership and staff regarding the principles of Medicare reimbursement, other third-party payment systems and population health and value-based systems.

Collaborates with strategy and planning and operational champions to develop assumptions related to business planning; work with finance team members to support the develop pro forma reports.

Provides oversight of the staff, processes, and procedures necessary to evaluate and maintain financial analytics for fee-for-service contracts, alternative payment models and risk-based contracts.

Maintains constant communication with patient financial services and contracting to evaluate potential revenue enhancements and risks.

Provides oversight of the financial analysis and support to the 340B pharmacy team when evaluating potential 340B child sites.

Ensures the ongoing monitoring and maintenance of financial analytics for currently registered 340B locations.

Provides oversight of the staff, processes, and procedures to calculate and report reimbursement rates to be utilized in financial forecasts and budgets.

Provides direction for the development of the annual third-party reimbursement budget.

Provides oversight of the contract modeling functions and collaborates with Managed Care Contracting staff to ensure model assumptions are updated timely and accurately to support the evaluation of alternative payment options.

Provides education to system leadership and staff with to support the organizational vitality goals outlined by Finance Leadership.

Ensures staff embodies the ChristianaCare Way: Serve with Excellence and Love.

Promotes and encourages core values and teamwork to enhance service to the organization.

Leads team huddles as a Making Tomorrow Happen Core Leader.

Ensures adequate staff education and training; evaluate staff performance, identify areas for performance improvement and provide positive coaching if necessary.

Education and Experience Requirements:

BS/BA in Accounting or Finance; MS/MBA preferred.

Active professional certification of financial relevance desirable.

At least seven years of experience in a major acute care teaching hospital setting or equivalent.

Christiana Care Health System is an equal opportunity employer, firmly committed to prohibiting discrimination, whose staff is reflective of its community, and considers qualified applicants for open positions without regard to race, color, sex, religion, national origin, sexual orientation, genetic information, gender identity or expression, age, veteran status, disability, pregnancy, citizenship status, or any other characteristic protected under applicable federal, state, or local law.