The Director of Reimbursement serves as an internal consultant to PCH leadership for reimbursement and Medicare/Medicaid regulatory matters and is responsible for proposing, implementing, reviewing, and modifying all work related to revenue maximization strategies in compliance with federal, state and local laws/regulations. The Director is responsible for leading and coordinating the continued development of accounts receivable valuation, net revenue reporting capabilities, all third-party reimbursement and cost reporting functions. The Director is responsible for the maintenance and optimization of the newly implemented Crowe Revenue Cycle Analytics (RCA) tool. The Director brings high-level insight and perspective to analyze and interpret financial information that supports the overall financial vision for Phoenix Childrens Hospital and elevates the level of financial analytical information provided to the organization. The Director will ensure system-wide capabilities to evaluate/understand Phoenix Childrens net revenue performance, guiding critical business decisions. The Director is responsible for developing a high performing team of professionals aligned with the organizations goals and values.
- Family-Centered care that focuses on the need of the child first and values the family as an important member of the care team
- Excellence in clinical care, service and communication
- Collaborative within our institution and with others who share our mission and goals
- Leadership that set the standard for pediatric health care today and innovations of the future
- Accountability to our patients, community and each other for providing the best in the most cost-effective way.
Accounts Receivable Valuation and Net Revenue Reporting
- The Director enhances and manages processes for accounts receivable valuation and net revenue reporting. Maintains and optimizes the Crowe Revenue Cycle Analytics (RCA) tool. Lead team in development, analysis, and interpretation of complex financial reporting models during time-sensitive month end close reporting process. Design and explain month end summary reporting to senior leadership. Participates in annual CDM rate review and accurately incorporates changes into accounts receivable valuation and net revenue reporting.
Cost Report and Reimbursement
- Directs the completion of the annual Medicare cost report, Hospital Uniform Accounting Report (UAR), and other governmental reporting. Understands and analyzes Medicare cost report changes and the impacts to annual AHCCCS rate changes. Assesses financial impact of regulatory changes on net revenue. Identifies reimbursement maximization opportunities.
- In collaboration with Transplant leadership, ensures compliance with financial regulatory guidelines and provides education to correctly account for pre and post-transplant operating revenues and expenses. Coordinates gathering of data necessary to complete annual cost reports. Analyzes financial impact of regulatory changes to the Transplant book of business. Also analyzes managed care reimbursement to ensure maximized reimbursement is received.
- In collaboration with GME leadership, analyzes financial impact of GME resident arrangements, FTE caps, affiliate agreements, etc. Advises on GME-related regulatory compliance matters. Coordinates gathering of data necessary to complete annual cost reports. Monitors, account for and collect receivables due from affiliate hospitals and College of Medicine departments for resident services.
- Coordinates year-end financial audit and third-party audits as they relate to patient accounts receivable and third-party payor liabilities. Reviews, analyzes and interprets new generally accepted accounting principles and GASB reporting standards and implements changes in reimbursement accounting and financial reporting as necessary to comply with such standards.
Financial Forecast Development Oversight
- Directs the revenue budget and revenue forecasting process.
- Guides individuals and team towards desired outcome with minimal supervision, sets high performance standards, and delivers high quality services. Mentors team members to leverage strengths and increase skill set. Develops training to maximize and reach optimal individual and organizational goals. Provides leadership in strengthening internal communications with staff at all levels of the organization. Creates and promotes a positive and supportive work culture.
Relationships and Communication
- Maintains positive working relationships with all individuals and leads collaboration with finance, revenue cycle, and managed care.
- Assures hospital compliance with federal, state, and local government laws and regulations, accrediting agency standards and hospital policies and procedures rules and regulations. Develop, document and implement departmental accounting policies, procedures, and standards.
- Performs miscellaneous job related duties as requested.