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Director Of Reimbursement

Lansing, MI, USA | Sparrow Health System

  • Industry:
    Healthcare - Hospitals
  • Position Type:
    Full-Time
  • Functions:
    General Management
  • Experience:
    10-12 years
Job Description:
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The Director of Reimbursement reports to the Sparrow Health System Vice President of Finance. The major function of this position is to provide leadership and direction for the health system's various Governmental and Other Third Party reimbursement processes. The Director of Reimbursement is responsible for the financial management and analysis for the organization's reimbursement department, part of the system's Finance Division.


Essential Duties:


This job description is intended to cover the minimum essential duties assigned on a regular basis.Associates may be asked to perform additional duties as assigned by their leader. Leadership has the right to alter or modify the duties of the position.


Provide leadership in developing all aspects of the annual and longer range financial plans of the health system as it relates to the area of third party reimbursement and net revenue.

Support the Executive Team, Governing Boards and Medical Staff in analysing all third party reimbursement aspects of the health system operations.

Determine staff needs and standards of productivity, develop a highly effective reimbursement team and establish procedures, standards and job classifications to meet the challenges of the healthcare finance and reimbursement arena.

Represent the Health System, as assigned by Controller or Vice President of Finance, in its relationship with other health agencies, organizations and groups in dealing with government agencies at the State, National or Local level. Maintain professional affiliations and enhance professional growth and development by keeping abreast of the latest trends, rules and regulation guiding healthcare financing and policy.

Medicare Reimbursement: Primary responsibility for system-wide annual and interim Medicare cost reporting and reimbursement analysis. This includes knowledge and expertise using the rules, regulations and guidance pertaining to Acute Care, Psychiatry, Rehabilitation and Critical Access Hospital components. Primary responsibility for all Medicare cost reporting and any Medicare MAC follow up including tentative and final settlements, audits and PRRB appeals if necessary. Provide leadership in the area of Medicare reimbursement for purposes of third party accounting on a monthly and annual basis.

Review and analyse all Medicare rule and regulation guidance effecting Medicare reimbursement. Review all Federal Regulation changes influencing PPS and CAH Medicare payment.

Medicaid Reimbursement: Primary responsibility for understanding all Medicaid reimbursement, rate and net revenue payment rules and concepts. This includes a working knowledge of Medicaid FFS reimbursement and that of the Medicaid Health Plans (HMO's). Understand the State of Michigan regulatory guidance concerning the various Federal governmental transfer and funding pool programs, including MACI, HRA, QAAP, Psychiatry, GME, Etc.

Responsible for all Medicaid cost reporting, DSH audits and other periodic reporting required by the State of Michigan Medical Services Administration.

Responsible for contract knowledge and financial analysis as it relates to all third-party payment managed care contracting. The Reimbursement Department will be an integral component in providing analysis for the third-party accounting in the area of managed care. Provide financial leadership and direction in the area of managed care contracting, negotiation and financial analysis.

Represent the Health System, as assigned by Controller or Vice President of Finance, in its relationship with our affiliated organizations.

Follows established HIPAA privacy procedures when using or disclosing protected health information and procedures and protocols as defined under the HIPAA privacy and security procedures.

Job Requirements

General Requirements• NA

Work Experience• Minimum 10 years of Healthcare Financial Management experience

Education• Bachelor of Science in Accounting, Business Administration, or Finance


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