AVP Enterprise Reimbursement

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Responsible for the planning, coordination, and direction of net revenue, regulatory reporting and strategic pricing initiatives for all enterprise entities within West Virginia University Health System (WVUHS).

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Bachelor’s Degree in Business with a major in Accounting or Finance.

EXPERIENCE:

1. Ten (10) years health care experience in healthcare finance, accounting or reimbursement.

2. At least Seven (7) years of experience in management.

3. Requires highly specialized finance and reimbursement knowledge of academic medical centers, community hospitals and critical access hospitals.

4. Requires developed skills in Net revenue, Medicare Cost Reports, Strategic Pricing and regulatory reporting required by the Federal and State government. Proven business judgment, and highly developed communication and presentation skills. 

PREFERRED QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Master’s degree in accounting, finance, or business administration

2. CPA certification

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1. Establishes and maintains policies, processes, and best practices for reimbursement functions across all enterprise entities, including Medicare Cost Reporting, monthly and annual financial reporting, required state reporting. Ensures consistency across all enterprise entities.

2. Establishes and maintains financial and operating performance standards based upon WVUHS requirements and industry standards.

3. Responsible for compliance with and oversight of all third party reimbursement regulations at both the state and federal level. Includes the oversight and review of the financial impact of any changes in reimbursement and ensuring that senior leadership and the CEO’s at all enterprise entities are informed of the financial impact of any significant changes. Includes identifying opportunities to improve reimbursement.

4. Responsible for oversight of the implementation and optimization of the Net revenue tools (Kodiak) and Medicare cost reporting work paper tool (Absolute).

5. Provides financial oversight to Information Technology regarding system conversions, updates, and installations of financial applications such as EPIC, Kodiak and StrataJazz. Provides direction to ensure consistency across all enterprise entities.

6. Directs and provides oversight to external auditors on the completion of annual financial audits of all enterprise entities in regard to the reimbursement functions. Directly reviews and monitors corrective action plans regarding management letter and other recommendations for improving and/or correcting deficiencies

7. Responsible for the oversight and completion of the net revenue budgets for all hospital entities consistent with WVUHS budget guidelines.

8. Monitors the long and short-term reimbursement performance and position for all enterprise entities to identify variances and key trends that affect financial viability. Facilitates early recognition of changes in financial circumstances so that timely operating adjustments can be made when necessary. Supports executive management at all enterprise entities as necessary.

9. Establishes and maintains reporting requirements necessary for effective management of reimbursement performance for all entities..

10. Reviews key net revenue financial discrepancies with CEO, senior management, and key finance and operating staff..

11. Responsible for continually evaluating reimbursement opportunities and financial viability of services as part of the overall margin improvement program, focused on improving operating margins of all enterprise entities.

12. Responsible for the oversight and completion of the net revenue for the rolling forecast and strategic long term financial forecast for all enterprise entities. Oversees net revenue projection assumptions and projections to assist with long range financial decision making. Works collaboratively with senior leadership to ensure consistency across all enterprise entities.

13. Responsible for net revenue analyses of financial performance and financial position while evaluating purchase options and parameters of potential merger partners, physician partnerships, and other new business opportunities.

14. Responsible for the timely completion of feasibility studies regarding affiliations, acquisitions, expense control, revenue enhancement, contractual arrangements, etc., to allow for decision making.

15. Assists with the completion of financial due diligence for identifying financial risks and potential liabilities of entities being acquired, affiliated, or merged with the Hospital or any of its subsidiary corporations.

16. Reports analyses of financial performance and financial position to the Board of Directors, Finance Committee, and other applicable Board designated committees (as required).

17. Gathers competitive, publicly available information regarding net revenue, margins, and other data necessary for understanding competitor strategies, strengths and weaknesses as needed.

18. Works collaboratively with the WVU Medicine senior management team, SOM leadership, and WVUHS executive, leadership by providing timely assistance related to financial matters.

19. Maintains an excellent rapport with executives, physicians, management and staff and gains cooperation while working toward institutional goals and objectives. Requires establishing trust and credibility among all constituents.

20. Models adaptive behavior by demonstrating a proactive attitude and enthusiasm while exhibiting patience with different cultures and divisions of all enterprise entities. Demonstrates honesty, integrity and a strong work ethic.

21. Demonstrates strategic thinking and effectiveness by identifying future needs and problem areas, developing workable solutions, and following through on solutions.

22. Takes immediate action upon the discovery of serious discrepancy situations. Documents actions and rationale for decision.

23. Assists CFO at each entity in establishing and maintaining communication protocol and standards for informing Board of Directors, Finance Committees, executives, physicians, management, and staff of applicable and appropriate net revenue and regulatory reporting matters.

24 Maintains personal program to improve professional and business skills necessary for high-level performance within the position. Attends meetings and seminars to maintain knowledge of current trends and developments in the field, presents information obtained as in service training sessions as necessary.

25. Supports or participates on various WVU Medicine committees as appointed. Serves on various WVUHS, state or local committees regarding regulatory reporting and reimbursement issues for hospitals and health care facilities as needed.

26. Assists the compliance officer in the assessment, correction, implementation, and enforcement of fraud and abuse issues related to the Hospital enterprise compliance program.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Office work which includes sitting for extended periods of time.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Office work which includes sitting for extended periods of time.

2. Occasional travel between facilities/buildings and throughout the region.

Additional Job Description:

Scheduled Weekly Hours:

40

Shift:

Exempt/Non-Exempt:

United States of America (Exempt)

Company:

SYSTEM West Virginia University Health System

Cost Center:

540 SYSTEM Finance and Reimbursement

Address:

3040 University Ave

Morgantown

West Virginia

WVU Medicine is proud to be an Equal Opportunity employer. We value diversity among our workforce and invite applications from all qualified applicants regardless of race, ethnicity, culture, gender, sexual orientation, sexual identity, gender identity and expression, socioeconomic status, language, national origin, religious affiliation, spiritual practice, age, mental and physical ability/disability or Veteran status.