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Connecticut Children's · 5 days ago

Sr Director - Revenue & Reimbursement

Hartford, CT

Full-time

Onsite

Director/Executive

10+ years exp

Connecticut Children's is the only health system in Connecticut dedicated entirely to children, offering personalized medical care across various pediatric specialties. The Senior Director of Revenue and Reimbursement will serve as a strategic partner to the finance team, overseeing managed care negotiations, revenue reporting, and the operational performance of the revenue cycle.

Health CareHospitalMedical

Responsibilities

Analyze contract and rate proposals & recommend counter proposal terms, provides distinctive technical/functional expertise and leadership for the organization objectives

Review all existing hospital and specialty group agreements and recommend alternative contractual language where ambiguous or detrimental terms and provisions exist

Research applicable global billing payment models for possible application to business and/or expansion to other chronic illnesses, challenges Hospital/Specialty Group assumptions when necessary based on data in order to be a change agent to sustain and ensure current and future success

Develop and negotiate provider agreements & contractual payment terms for medical center and affiliate organizations. Build strong payer relationships and lasting partnerships, and influences stakeholders to address internal or external business and regulatory issues

Directs the development and maintenance of hospital and specialty group contract modeling systems for payment verification and contract negotiations. Develop strategic pricing within payer agreements that align with organizational strategic focus and growth initiatives while keeping pace with market trends

Oversight of Revenue Cycle month end close submission, including preparation of monthly and YTD reimbursement related financials/statistics along w/ key operating metrics. Manage internal and external ad hoc data requests for hospital and group as needed

Act as a gatekeeper / liaison to Revenue Cycle consortium’s key performance indicators and other financial related exchanges. Review and approve all job requests from revenue cycle to conform to budgetary and operational requirements

Based on results of the reports surrounding the contract modeling systems, developing payer scorecards to share with payer representatives to highlight the strengths and opportunities that each payer has and must address with respect to their performance to the contract. It is vital that this role actively work with payer representatives to improve both Connecticut Children’s performance and the payers’ performance to the contract

Serve as a key contact point for physicians, PFS, Billing and Remit staff for any payer related questions, comments and criticism and serve as the liaison to report those items to the payers to resolve issues Connecticut Children’s is experiencing

Take the lead in responding to audit requests related to the organizations revenue for the annual financial statement audit and for any agency or payer audits. Utilizing staff to pull data and review/validate accuracy

Act as liaison with hospital and specialty group PFS teams regarding contract interpretation issues, including maintaining system updates related to rates/contract terms. As necessary and appropriate, attend Epic User Group meetings and training offerings around the contract module to ensure continued maintenance of the contracts is efficient and effective, and contracts modules are maintained current and accurate

Act as hospital and specialty group finance liaison during JOC meetings with managed care organizations and PFS representatives

Research and develop pay-for-performance models and Episode of Care payment methodologies under an ACO model, or similar alterative risk models

Demonstrates support for the mission, values and goals of the organization through behaviors that are consistent with Connecticut Children’s Core Leadership Behaviors

Ensure all regulatory/government and other agency (such as CHA, CHCA) data submissions for monthly/annual filings are completed on time

Expert in Medicaid reimbursement and other government programs. Support Government Relations and EMT in assessing and quantifying Medicaid financial metrics related to reimbursement or policy changes. Utilizing staff to examine and analyze changes in the Medicaid program to determine impact of the changes on the Medical Center and Group businesses. Make recommendations as appropriate to government relations staff to help to shape Connecticut Children’s response to policy or rate changes

Supports broader finance team in Revenue Integrity, strategic pricing and charge structure and provide recommendations. Review and recommend reimbursement rates, methodologies and contract language in partnership arrangements. Represent reimbursement interests and payer negotiations in organizational efforts to build integrated networks and partnerships

Lead strategic pricing initiatives and ongoing review/analysis. Maintain health system’s efforts to provide competitive and transparent pricing to address federal regulations

Qualification

Healthcare financeContract negotiationReimbursement strategiesData analysisEPIC proficiencyMicrosoft OfficeLeadership experienceInterpersonal skillsCommunication skillsTeamwork

Required

Bachelor's degree in a quantitative/analytical discipline as well as a Master's degree required

At least 5 years of experience within healthcare setting and/or healthcare consulting

At least 5 years of management and leadership experience

Minimum of 10 years of progressive experience leading organizational reimbursement strategies, contract modeling and contract/rate proposals, including negotiations

Advanced knowledge of organizational and departmental structure, systems, workflow, and operations policies/procedures pertaining to reimbursement, billing, collections and revenue cycle management

Advanced knowledge of third party payer requirements and state/federal regulations pertaining to hospital and professional reimbursement

Advanced knowledge of healthcare finance, budgeting and fiscal management concepts and theories

Working knowledge of risk based models

Advanced knowledge of reporting systems and database structure to understand and interpret data

Advanced knowledge of EPIC to direct contract modeling and proration efforts

Working knowledge of Microsoft Windows operating system; Intermediate skills in Microsoft Office

Evaluating operations and procedures, formulating policy and developing and implementing new strategies and procedures

Exceptional interpersonal skills and the ability to interact and work effectively with medical center leadership, government agencies, physicians, third party payers

Advanced verbal and written communication skills and the ability to present effectively to small and large groups

Experience in EPIC and contract management tools

Ability to delegate tasks to staff as appropriate and maximize value by focusing on high level initiatives

Use independent judgment and to appropriately manage and impart information to a range of constituents

Foster a cooperative work environment

Organize resources and establish priorities

Develop, plan and implement short and long-range goals

Persuade and influence others

Ensure quality outcomes and continuous improvement of work processes

Company

Connecticut Children's

Connecticut Children’s is a leading pediatric academic medical center consistently ranked by our peers as among the best children’s hospitals in the nation.

Founded in 1996

Hartford, Connecticut, USA

1001-5000 employees