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Discover Vanderbilt University Medical Center: Located in Nashville, Tennessee, and operating at a global crossroads of teaching, discovery, and patient care, VUMC is a community of diverse individuals who come to work each day with the simple aim of changing the world. It is a place where your expertise will be valued, your knowledge expanded, and your abilities challenged. Vanderbilt Health recognizes that diversity is essential for excellence and innovation. We are committed to an inclusive environment where everyone has the chance to thrive and where your diversity of culture, thinking, learning, and leading is sought and celebrated. It is a place where employees know they are part of something that is bigger than themselves, take exceptional pride in their work and never settle for what was good enough yesterday. Vanderbilt’s mission is to advance health and wellness through preeminent programs in patient care, education, and research.

Organization:

Finance - Reimbursement Strate

Job Summary:

The primary purpose of this position is to lead the most advanced analysis of strategic and financial matters related to Revenue and Reimbursement Strategy. This role will be responsible for projects which involve both hospital and professional business and will interact with all levels of institutional personnel. Technical knowledge base should include:

Hospital and /or professional financial analysis and third party reimbursement

Federal & State Mandatory reporting

Gross and net revenue compilation (contractual allowance/deduction modeling)

Reimbursement Analytics

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Key Functions and Expected Performances:

Reimbursement Strategy:

• Provides recommendations and leadership for operational/strategic changes in support of Federal / State or other third party reimbursement initiatives.

• Leads or supports in the design and operational implementation of reimbursement focused projects/procedures across the institution, including providing technical reimbursement expertise, analytics and project management/facilitation.

• Recommends changes in operating practices, data collection, and information systems structures that will result in a reimbursement benefit through analysis of data and changes in regulations.

• Leads/Assists with production work relating to the filing of various regulatory reporting such as the Tennessee Joint Annual Report, IRS Form 990 Schedule H or specific components of the annual Medicare cost report. Can serve in the roles of preparer, coordinator or reviewer.

• Identifies reimbursement opportunities by reviewing past regulatory reporting for strategic opportunities.

• Remains abreast of new regulatory and/or requirement changes and provides advice on complying with a constantly changing environment.

• Provides support for compliance related matters impacting the organization where applicable to reimbursement.

• Assist colleagues in developing and submitting sensitive information to government officials.

• Champions important initiatives with sometimes difficult constituencies.

• Performs pro forma modeling and retrospective analyses to increase reimbursement.

• Develops strong relationships with clinical areas acting as a consultant regarding revenue/reimbursement matters.

• Serves as a consultant to the reimbursement production team on reimbursement matters.

• Performs special projects as assigned.

Federal & State R eporting and Defense

• Manages production aspects of Medicare & State reimbursement including completing mandatory State and /or Federal reporting (Medicare Cost report, Tennessee Joint Annual Report (JAR), Medicaid Disproportionate Share Hospital (DSH) are examples)

• Defends the hospital’s position of all audit of mandatory Federal and State reporting and other billing audits. Reviews all audit adjustments for propriety. Prepares recommendations for improvements as a result of the audits to other operating areas for disposition.

• Provides support to the State Financial Reporting Department for the completion of the Federal Indirect Cost proposal thus, a working knowledge of the OASC3- “Guide for Hospitals - -Cost Principles and Procedures for Establishing Indirect Cost and Patient Care Rates for Grants and Contracts" is needed. Remains abreast of new regulatory and/or requirement changes.

• Operationalizes into production all changes in operating practices, data collection, and information systems structures that will result in a reimbursement benefit through analysis of data and changes in regulations.

• Coordinates implementation of strategic initiatives into production.

• Performs special projects as assigned.

Gross and Net Revenue: budgeting / forecasting / monthly close

• Compiles, analyzes and reviews data for financial reporting of gross & net revenues for budgeting, forecasting and monthly close.

• Calculates monthly realization/deduction rates and applies them to the current financial projects.

• Interprets and translates current and foreseeable business changes into recommendations and overall estimated impacts to current and future net revenue utilizing the best information available to predict and calculate potential impacts to gross and net revenue.

• Supervises, coordinates and defends complex regulatory audit inquiries; develops methods for managing and controlling communications with external audit team; develops methods for reporting audit findings to management; develop and present recommendations management regarding future corrective actions needed to facilitate compliance.

• Monitor and review regulatory changes impacting accounting procedures; coordinate and design. materials/forums to communicate and educate the Vanderbilt community regarding regulatory changes.

• Maximizes, monitors and reports predicted reimbursement/net revenues at the business unit level.

• Initiate appropriate levels of review within the business unit to ensure maintenance of adequate levels of internal control.

• Uses comprehensive knowledge of the role and goals of Vanderbilt departments, with an understanding of academic and healthcare accounting in accordance with generally accepted accounting principles (GAAP), applicable regulations, and Vanderbilt University Medical Center policies and procedures.

• Performs special projects as assigned.

Reimbursement Analytics:

• Leads extensive qualitative and quantitative analyses including revenue/reimbursement analysis, financial analysis, cost analysis, contract performance analysis, cost/benefits analysis, market analysis, and organizational analysis related to patient care reimbursement.

• Creates structured analytical approaches to unstructured questions or problems, adding one’s own insight in an ad hoc, interactive, analytical process. Work will be lead or performed at a variety of levels including: patient, program, payor, clinic, disease-site, point of entry, and others. Requires knowledge of clinical operations, billing, and coding.

• Researches and analyzes outcomes at the patient detail level using available systems for hospital and professional services including the electronic health record.

• Demonstrates proficiency in the hospital/professional financial and patient care decision support database tools. Analyzes and interprets data from these databases and provides information to management.

• Designs and/or writes complex SQL (structured query language) queries in a variety of decision support systems or a data warehouse.

• Provides direction and/or performs data extraction over large collections of data. Consolidates, summarizes, or transforms transaction data to support analytical reporting and trend analysis.

• Reviews and analyzes reconciliations and resolves discrepancies between the patient accounting system and the various decision support systems.

• Assists with the compilation of various regulatory reporting. Examples include the Tennessee Joint Annual Report, IRS Form 990 Schedule H or specific components of the annual Medicare Cost Report.

• Evaluates operational and programmatic needs and identifies appropriate data analysis approaches and technologies to meet those needs.

• Develops tools for use in evaluating strategic decisions based on operations and/or product line information.

• Performs special projects as assigned.

Project Leadership/Management & Customer Service:

• Provides simultaneous leadership on multiple projects and areas of expertise, including project management of assigned projects and organizing team activities.

• Establishes appropriate mechanisms and goals to monitor project time lines and reporting to appropriate parties. Assess achievement of agreed upon project goals and communicate results. Make modifications to program plans, as necessary to achieve desired goals.

• Educates leaders and physicians on reimbursement matters, opportunities, and risks.

• Supervises, plans, directs, coordinates, and evaluates the work product of employees who assist with any of the work described in the major subject matter areas detailed in the job description.

• Interfaces and maintains appropriate service with customers including hospital management and physicians.

• Presents findings as required to a variety of audiences using excellent written and oral communication skills to communicate results/impacts.

• Thoroughly documents analysis work for consistency and reproducibility.

• Develops and leads technical training/education of project team members and customers. Provides mentoring relating to specific areas of expertise as needed/requested.

• Demonstrates sound judgment and good decision making skills.

Position Experience:

• Experience with gross and net revenue modeling, budgeting and forecasting

• Experience with Medicare cost report filing

• Experience with patient care level data analysis and reporting

• Experience with business intelligence tools and Standard Query Language (SQL).

• Knowledge of various processes associated with revenue cycle in a complex business environment. Examples include patient billing services, patient access services, pricing master and third party contracting knowledge

• Experience with Microsoft office programs

• Working knowledge of hospital or professional patient accounting systems

• Ability to gather relevant information systematically and breakdown problems into simple components and make sound decisions

• Ability to contribute innovative thinking and new ideas/solutions in a multidisciplinary team environment

Preferred Skills

• Experience with Vanderbilt University Medical Center (VUMC)

• Hands on experience with Business Objects, Medipac, EPIC, or Hyperion

• Knowledge of third party contracting concepts

• Familiarity with an Electronic Medical Record

• Knowledge of cost accounting

• Familiarity with charge description master

• Knowledge of ICD CM and coding

• Knowledge of current Federal and State regulations impacting reimbursement

• Excellent presentation and communication skills

Education and Certifications

Masters degree or equivalent years of experience (preferred but not required)

CPA (preferred but not required)

Experience

Highly recommended: Eight years of experience in Federal cost reporting, net / gross revenue support, or patient care level decision support analytics in a large healthcare environment, hospital, physician practice, third party payer, Medicare intermediary or accounting/consulting firm.

Preferred: Ten years of experience in Federal cost reporting, net / gross revenue support, or patient care level decision support analytics in a large healthcare environment, hospital, physician practice, third party payer, Medicare intermediary or accounting/consulting firm.

Our professional administrative functions include critical supporting roles in information technology and informatics, finance, administration, legal and community affairs, human resources, communications and marketing, development, facilities, and many more.

At our growing health system, we support each other and encourage excellence among all who are part of our workforce. High-achieving employees stay at Vanderbilt Health for professional growth, appreciation of benefits, and a sense of community and purpose.

Core Accountabilities:

Organizational Impact: Independently delivers on objectives with understanding of how they impact the results of own area/team and other related teams. Problem Solving/ Complexity of work: Utilizes multiple sources of data to analyze and resolve complex problems; may take a new perspective on existing solution. Breadth of Knowledge: Has advanced knowledge within a professional area and basic knowledge across related areas. Team Interaction: Acts as a "go-to" resource for colleagues with less experience; may lead small project teams.

Core Capabilities :

Supporting Colleagues: - Develops Self and Others: Invests time, energy, and enthusiasm in developing self/others to help improve performance e and gain knowledge in new areas. - Builds and Maintains Relationships: Maintains regular contact with key colleagues and stakeholders using formal and informal opportunities to expand and strengthen relationships. - Communicates Effectively: Recognizes group interactions and modifies one's own communication style to suit different situations and audiences. Delivering Excellent Services: - Serves Others with Compassion: Seeks to understand current and future needs of relevant stakeholders and customizes services to better address them. - Solves Complex Problems: Approaches problems from different angles; Identifies new possibilities to interpret opportunities and develop concrete solutions. - Offers Meaningful Advice and Support: Provides ongoing support and coaching in a constructive manner to increase employees' effectiveness. Ensuring High Quality: - Performs Excellent Work: Engages regularly in formal and informal dialogue about quality; directly addresses quality issues promptly. - Ensures Continuous Improvement: Applies various learning experiences by looking beyond symptoms to uncover underlying causes of problems and identifies ways to resolve them. - Fulfills Safety and Regulatory Requirements: Understands all aspects of providing a safe environment and performs routine safety checks to prevent safety hazards from occurring. Managing Resources Effectively: - Demonstrates Accountability: Demonstrates a sense of ownership, focusing on and driving critical issues to closure. - Stewards Organizational Resources: Applies understanding of the departmental work to effectively manage resources for a department/area. - Makes Data Driven Decisions: Demonstrates strong understanding of the information or data to identify and elevate opportunities. Fostering Innovation: - Generates New Ideas: Proactively identifies new ideas/opportunities from multiple sources or methods to improve processes beyond conventional approaches. - Applies Technology: Demonstrates an enthusiasm for learning new technologies, tools, and procedures to address short-term challenges. - Adapts to Change: Views difficult situations and/or problems as opportunities for improvement; actively embraces change instead of emphasizing negative elements.

Position Qualifications:

Responsibilities:

Certifications:

Work Experience:

Relevant Work Experience

Experience Level:

4 years

Education:

Bachelor's

Vanderbilt Health recognizes that diversity is essential for excellence and innovation. We are committed to an inclusive environment where everyone has the chance to thrive and to the principles of equal opportunity and affirmative action. EOE/AA/Women/Minority/Vets/Disabled