Director of Reimbursement
Come Grow With Us at Springfield Clinic!
Excellent Opportunity to advance your career as our Director of Reimbursement with a top progressive, physician-led multispecialty medical group in Springfield, IL.
The Director of Reimbursement is responsible for providing strategic leadership, financial and administrative oversight for all reimbursement tasks for the Clinic, including reviewing documents, maintaining financial information and analyzing reimbursement options. They also work closely with Finance, Revenue Cycle and Administration regarding reimbursement statuses, business planning and development.
Reports to the VP and Chief Financial Officer
- Develop and implement reimbursement strategy for the organization.
- Ensure compliance with regulations and billing and collections policies in order to facilitate attainment of accounts receivable targets.
- Perform ongoing trend analysis on third party payment levels to ensure that reimbursement is in accordance with allowable amounts stated in agreements and contracts. Work with appropriate individuals to resolve discrepancies.
- Review and audit the third party adjustment model to ensure provider estimates are comprehensive and accurate.
- Calculate Clinic’s overall monthly provision for contractual and bad debt allowances.
- Perform hindsight testing to ensure the accuracy and integrity of the provision calculation.
- Perform ongoing trend analysis of third party payer rejects and denials.
- Prepare and utilize financial analyses in third party and managed care negotiation payer process.
- Monitor, review, and negotiate third party payer contracts.
- Demonstrate professional behavior in association with providers, patients, vendors and Clinic staff both within and outside the Clinic.
- Assist CFO with all projects within related scope of responsibility.
- Follow all Clinic, Accounting, Financial Planning and Analysis, and Reimbursement policies and procedures.
- Maintain a positive attitude in working to achieve Clinic goals.
- Comply with the Springfield Clinic incident reporting policy and procedures.
- Adhere to all OSHA and Springfield Clinic training & accomplishments as required per policy.
- Provide excellent customer service and adhere to Springfield Clinic's Code of Conduct and Ethics Standards.
- Perform other job duties as assigned.
- Bachelor’s degree in Accounting, Health Care Administration or Business Administration required. Master’s Degree preferred.
- Minimum five (5) years of healthcare reimbursement analysis experience with tools such as MS Access, advance user level Excel, visualization tools, etc.
Knowledge, Skills and Abilities
- Strong knowledge of various software applications such as Allscripts, Touchworks, MS Office and other clinical applications preferred.
- Strong working knowledge of medical terminology, CPT, HCPCS, ICD9 and ICD10.
- Knowledge of pertinent Federal, State and local laws, codes and regulations related to patient billing and collection.
- Demonstrates attention to detail in data gathering, specifications development, documentation and record keeping.
- General knowledge of healthcare industry, clinical and business operation functions.
- Ability to manage multiple concurrent priorities while representing good organizational skills.
- Ability to perform well in a highly collaborative environment.
- Excellent interpersonal skills and the ability to communicate and collaborate effectively with users, colleagues and developers on both a technical and non-technical level.
- Ability to provide reliable transportation to commute between Clinic facilities as required for Clinic operations.
- This is a challenging position requiring excellent interpersonal skills, ability to function in a fast paced short-deadline environment, and create innovative results using software applications available for data analysis.
- This job operates in a professional office environment. Routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.