VP Reimbursement

Job Description

Description

Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.

Summary:

Reporting to the Chief Revenue Officer, the System Vice President of Reimbursement is responsible for Medicare and Medicaid reimbursement initiatives  for all of the providers of care (owned and managed) throughout UNC Health. The leader is accountable for development, implementation, and maintenance of payment models for supplemental payments. This position works closely with governmental agency leaders, other hospital leaders, and North Carolina Healthcare Association (NCHA), as well as legislative contacts, ensuring state plan amendments, legislative and budget language align with the initiatives, while remaining compliant with State and Federal regulations. The System VP of Reimbursement must partner with Legislative and Governmental Affairs, other HCS executive leaders and entity CEO’s and CFO’s.

This position works closely with UNCHCS leaders educating and ensuring the new department or entity initiatives are compliant with the applicable CMS regulations for associated provider types (i.e., CMS regulations for IDTF, ERSD, ASC, etc.). The position also educates ambulatory leaders and completes the CMS attestations that ensure compliance with the CMS provider based regulations. The position is responsible for filing the Medicare and Medicaid enrollment/revalidation applications following the Federal and State enrollment regulations to ensure that the providers of care remain in good standing and are allowed to provide care to the Medicare and Medicaid patients and be paid accordingly. This position attends work groups at NCHA as well as on point for Medicaid payment and enrollment issues with Medicaid. This position is responsible to all of the CFO’s in the System’s hospitals and nursing facilities to file the CMS required cost reporting, statements, Wage Index, Occupational Mix and Medicaid reports and other such regulatory reimbursement reporting as shall become required under law or regulation.

The System VP Reimbursement oversees the system appeals for Medicare payment issues for broad issues, specific claims and cost report issues such as DSH. The System VP of Reimbursement establishes and maintains relationships with third party payors and appropriate government agencies to assure compliance with updates and changes as they arise. 

Responsibilities:

Leading People - Leads people toward meeting the organization's vision, mission, and goals. Provides an inclusive workplace that fosters the development of others, facilitates cooperation and teamwork, and supports constructive resolution of conflicts. Encourages workforce engagement by building a commitment to excellence and by promoting the organization's vision internally and externally. Delegates’ responsibility clarifies expectations and holds others accountable for achieving results related to their area of responsibility. Leads in a deliberate and predictable way and operates with transparency. Treats sensitive or confidential information appropriately. Develops the ability of others to perform and contribute to the organization by providing ongoing feedback and by providing opportunities to learn through formal and informal methods. Manages and resolves conflicts and disagreements in a constructive manner.

Leading Change - Acts as a catalyst for organizational change. Influences others to translate vision into action. Brings about strategic change, both within and outside the organization, to meet organizational goals. Establishes an organizational vision and implements it in a continuously changing environment. Is open to change and new information and rapidly adapts to new information, changing conditions, or unexpected obstacles. Deals effectively with pressure and remains optimistic and persistent, even under adversity. Recovers quickly from setbacks. Formulates objectives and priorities, and implements plans consistent with the long-term interests of the organization. Capitalizes on opportunities and manages risks. Takes a long-term view and builds a shared vision with others.

Results Driven - Exceeds organizational goals and customer expectations. Makes decisions that produce high-quality results by applying technical knowledge, analyzing problems, and calculating risks. Holds self and others accountable for measurable high-quality, timely, and cost-effective results. Delivers high-quality services and is committed to continuous improvement. Fosters a culture of safe and compassionate patient care. Makes well-informed, timely decisions, even when data are limited or solutions produce unfavorable results. Positions the organization for success by identifying new opportunities and builds the organization by developing and improving services. Leads the budgeting process. Uses cost-benefit thinking to set priorities, monitors expenditures in support of programs and policies, and identifies cost-effective approaches.

Qualifications

Education Requirements:
● Requires Bachelor’s degree. Accounting degree preferred. Master’s degree strongly preferred.
Licensure/Certification Requirements:
● No licensure or certification required.
Professional Experience Requirements:
● Requires 10-12 years of progressively responsible healthcare finance, reimbursement or revenue experience.
Knowledge/Skills/and Abilities Requirements:
● Solves complex problems that may have a long-term impact on the business function/line of business. Develops innovative ideas and solutions with significance to the organization’s future. Identifies problem areas and skill gaps proactively and addresses them appropriately. Excellent project management and change management skills for designing and implementing Entity, Triangle, or System initiatives in a complex environment.

Job Details

Legal Employer: NCHEALTH

Entity: Shared Services

Organization Unit: Reimbursement 

Work Type: Full Time

Standard Hours Per Week: 40.00

Work Schedule: Day Job

Location of Job: US:NC:Chapel Hill

Exempt From Overtime: Exempt: Yes

This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Heath Care System. This is not a State employed position.