Sr Director - Revenue & Reimbursement

The Senior Director of Revenue and Reimbursement is a trusted strategic partner to the health system’s SVP Finance/CFO as well as the broader executive management team. As a member of the Finance Leadership Team, serves as a partner to executives on key initiatives and issues, is responsible for translating organizational and functional strategy into departmental strategy, operational plans, and owns department performance. Primary source of decisions related to managed care negotiations and strategy, net revenue reporting for financials, net revenue consultation for business planning and analysis, pricing and rate setting strategies. Serves as a key connection point between revenue cycle operations and financial performance. The Senior Director of Revenue and Reimbursement is responsible for: the direction of all key managed care strategic decisions, including the management and negotiations of current and prospective managed care contracts for the hospital & specialty group, and reimbursement methodologies of CT. Coordinates the data analysis function for both current and prospective contracts and rate models. Responsibilities Analyze contract and rate proposals & recommend counter proposal terms, provides distinctive technical/functional expertise and leadership for the organization objectives. Review all existing hospital and specialty group agreements and recommend alternative contractual language where ambiguous or detrimental terms and provisions exist. Research applicable global billing payment models for possible application to business and/or expansion to other chronic illnesses, challenges Hospital/Specialty Group assumptions when necessary based on data in order to be a change agent to sustain and ensure current and future success. Develop and negotiate provider agreements & contractual payment terms for medical center and affiliate organizations. Build strong payer relationships and lasting partnerships, and influences stakeholders to address internal or external business and regulatory issues. Directs the development and maintenance of hospital and specialty group contract modeling systems for payment verification and contract negotiations. Develop strategic pricing within payer agreements that align with organizational strategic focus and growth initiatives while keeping pace with market trends. Oversight of Revenue Cycle month end close submission, including preparation of monthly and YTD reimbursement related financials/statistics along w/ key operating metrics. Manage internal and external ad hoc data requests for hospital and group as needed. Act as a gatekeeper / liaison to Revenue Cycle consortium’s key performance indicators and other financial related exchanges. Review and approve all job requests from revenue cycle to conform to budgetary and operational requirements. Based on results of the reports surrounding the contract modeling systems, developing payer scorecards to share with payer representatives to highlight the strengths and opportunities that each payer has and must address with respect to their performance to the contract. Serve as a key contact point for physicians, PFS, Billing and Remit staff for any payer related questions, comments and criticism and serve as the liaison to report those items to the payers to resolve issues. Take the lead in responding to audit requests related to the organizations revenue for the annual financial statement audit and for any agency or payer audits. Act as liaison with hospital and specialty group PFS teams regarding contract interpretation issues, including maintaining system updates related to rates/contract terms. Act as hospital and specialty group finance liaison during JOC meetings with managed care organizations and PFS representatives. Research and develop pay-for-performance models and Episode of Care payment methodologies under an ACO model, or similar alterative risk models. Demonstrates support for the mission, values and goals of the organization through behaviors that are consistent with Connecticut Children’s Core Leadership Behaviors. Ensure all regulatory/government and other agency data submissions for monthly/annual filings are completed on time. Expert in Medicaid reimbursement and other government programs. Supports broader finance team in Revenue Integrity, strategic pricing and charge structure and provide recommendations. Lead strategic pricing initiatives and ongoing review/analysis. Qualifications Bachelor's degree in a quantitative/analytical discipline as well as a Master's degree required At least 5 years of experience within healthcare setting and/or healthcare consulting At least 5 years of management and leadership experience Minimum of 10 years of progressive experience leading organizational reimbursement strategies, contract modeling and contract/rate proposals, including negotiations. Knowledge, Skills And Abilities Required Advanced knowledge of organizational and departmental structure, systems, workflow, and operations policies/procedures pertaining to reimbursement, billing, collections and revenue cycle management. Advanced knowledge of third party payer requirements and state/federal regulations pertaining to hospital and professional reimbursement Advanced knowledge of healthcare finance, budgeting and fiscal management concepts and theories Working knowledge of risk based models. Advanced knowledge of reporting systems and database structure to understand and interpret data. Advanced knowledge of EPIC to direct contract modeling and proration efforts SKILLS: Working knowledge of Microsoft Windows operating system; Intermediate skills in Microsoft Office Evaluating operations and procedures, formulating policy and developing and implementing new strategies and procedures Exceptional interpersonal skills and the ability to interact and work effectively with medical center leadership, government agencies, physicians, third party payers Advanced verbal and written communication skills and the ability to present effectively to small and large groups ABILITY TO: Delegate tasks to staff as appropriate and maximize value by focusing on high level initiatives Use independent judgment and to appropriately manage and impart information to a range of constituents Foster a cooperative work environment Organize resources and establish priorities Develop, plan and implement short and long-range goals Persuade and influence others Ensure quality outcomes and continuous improvement of work processes

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