Job Information
Billings Clinic Executive Director of Reimbursement in Billings, Montana
You’ll want to join Billings Clinic for our outstanding quality of care, exciting environment, interesting cases from a vast geography, advanced technology and educational opportunities. We are in the top 1% of hospitals internationally for receiving Magnet® Recognition consecutively since 2006.
And you’ll want to stay at Billings Clinic for the amazing teamwork, caring atmosphere, and a culture that values kindness, safety and courage. This is an incredible place to learn and grow. Billings, Montana, is a friendly, college community in the Rocky Mountains with great schools and abundant family activities. Amazing outdoor recreation is just minutes from home. Four seasons of sunshine!
You can make a difference here.
About Us
Billings Clinic is a community-owned, not-for-profit, Physician-led health system based in Billings with more than 4,700 employees, including over 550 physicians and non-physician providers. Our integrated organization consists of a multi-specialty group practice and a 304-bed hospital.Learn more (https://www.billingsclinic.com/about-us/) about Billings Clinic (our organization, history, mission, leadership and regional locations) and how we are recognized nationally for our exceptional quality.
Your Benefits
We provide a comprehensive and competitive benefits package to all full-time employees (minimum of 24 hours/week), including Medical, Dental, Vision, 403(b) Retirement Plan with employer matching, Defined Contribution Pension Plan, Paid Time Off, employee wellness program, and much more.Click here (https://www.billingsclinic.com/careers/employee-benefits/) for more information ordownload the Employee Benefits Guide (https://ncstoragemlbillings.blob.core.windows.net/public/2021%20Billings%20Clinic%20Staff%20Benefits%20Guide.pdf) .
Magnet: Commitment to Nursing Excellence
Billings Clinic is proud to be recognized for nursing excellence as a Magnet®-designated organization, joining only 97 other organizations worldwide that have achieved this honor four times. The re-designation process happens every four years. Click here (https://www.billingsclinic.com/campaign-landing-pages/magnet/) to learn more!
Pre-Employment Requirements
All new employees must complete several pre-employment requirements prior to starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more!
Executive Director of Reimbursement
REIMBURSEMENT (Billings Clinic Main Campus)
req8385
Shift: Day
Employment Status: Full-Time (.75 or greater)
Hours per Pay Period: 1.00 = 80 hours (Exempt)
Starting Salary DOE
This position is responsible to provide the leadership, direction, and education for all aspects of Reimbursement Services for Billings Clinic - Logan Health to include facilitating the contractual all aspects of the net patient revenue accounting, preparation of the Medicare and Medicaid cost reports (including maintaining models and providing decision support), financial analysis regarding payor reimbursement proposals, cost analysis for pricing strategies, auditing functions for reimbursement, and other projects related to reimbursement. Leadership accountabilities include business development, quality of services, short- and long-range planning related to the Reimbursement Services, to achieve goals and objectives, fiscal control and responsibility to manage organizational revenue and costs and personnel management. This role acts as a strategic advisor to senior management in regard to pricing, reimbursement and services. The incumbent is recognized as an area expert within Billings Clinic-Logan Health and to other health care providers.
Essential Job Functions
• 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 including state bed tax, Schedule H. Ensures consistency across all enterprise entities.
• Establishes and maintains financial and operating performance standards based upon Billings Clinic- Logan Health requirements and industry standards.
• 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 and CFO’s at all enterprise entities are informed of the financial impact of any significant changes. Includes identifying opportunities to improve reimbursement.
• Responsible for oversight of the implementation and optimization of the Net revenue tools and Medicare cost reporting work paper tool to include community hospitals, sole community hospitals, critical access hospitals, rural health clinics, and provider-based clinics.
• Responsible for accurate and timely preparation of documentation for Medicare, Medicaid, and other third-party cost reports for system facilities. Utilize outside consultant(s) as appropriate.
• Responsible for the preparation and maintenance of records related to hospitals’ Disproportionate Share Hospital (DSH) programs. Monitors DSH eligibility and communicates any risk to senior leadership as appropriate.
• Establishes best practice procedures, polices, and standardization regarding the Charge Description Master (CDM) to optimize strategic pricing and reimbursement.
• Provides financial oversight to Information Technology regarding system conversions, updates, and installations of financial applications such as Cerner, Meditech, Lawson and Axiom. Provides direction to ensure consistency across all enterprise entities.
• Directs and provides oversight to external auditors on the completion of annual financial audits of all enterprise entities regarding the reimbursement functions as well as any cost report or other reimbursement reviews or audits. Directly reviews and monitors corrective action plans regarding management letter and other recommendations for improving and/or correcting deficiencies
• Responsible for the oversight and completion of the net revenue budgets for all hospital and healthcare entities consistent with Billings Clinic- Logan Health budget guidelines.
• 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.
• Establishes and maintains reporting requirements necessary for effective management of reimbursement performance for all entities (PPS, CAH, SCH, RHC, etc)
• Reviews key net revenue financial discrepancies with CEO, CFO, senior management, and key finance and operating staff.
• 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.
• 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.
• 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.
• Responsible for the timely completion of feasibility studies and reimbursement analysis regarding affiliations, acquisitions, expense control, revenue enhancement, new services, contractual arrangements, etc., to allow for decision making.
• 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.
• Reports analyses of financial performance and financial position to the Board of Directors, Finance Committee, and other applicable Board designated committees (when requested).
• Gathers competitive, publicly available information regarding net revenue, margins, and other data necessary for understanding competitor strategies, strengths and weaknesses as needed.
• Works collaboratively with the Billings Clinic- Logan Health senior management team and communities’ leadership by providing timely assistance related to financial matters.
• 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.
• 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.
• Demonstrates strategic thinking and effectiveness by identifying future needs and problem areas, developing workable solutions, and following through on solutions.
• Takes immediate action upon the discovery of serious discrepancy situations. Documents actions and rationale for decision.
• 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.
• 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.
• Supports or participates on various Billings Clinic-Logan Health committees as appointed. Serves on various state or local committees regarding regulatory reporting and reimbursement issues for hospitals and health care facilities as needed.
• Assists the compliance officer in the assessment, correction, implementation, and enforcement of fraud and abuse issues related to the Hospital enterprise compliance program.
• Supports and models behaviors consistent with Billings Clinic’s mission, vision, values, code of business conduct and service expectations. Meets all mandatory organizational and departmental requirements. Maintains competency in all organizational, departmental and outside agency standards as it relates to the environment, employee, patient safety or job performance.
• Performs all other duties as assigned or as needed to meet the needs of the department/organization.
Minimum Qualifications
Education
• Graduate Degree in a related field
Experience
• 10 years of Healthcare Experience in healthcare finance, accounting, or reimbursement.
• 7 years of Management experience
• Requires highly specialized finance and reimbursement knowledge of community hospitals (PPS), critical access hospitals (CAH), sole community hospitals (SCH), clinics, rural health clinics (RHC), and provider-based clinics.
• Requires developed skills in financial analysis and financial planning, proven business judgment, and highly developed communication and presentation skills.
• Requires developed skills in net revenue, Medicare Cost reports, strategic pricing, regulatory reporting required by the Federal and State government.
Or an equivalent combination of education and experience relating to the above tasks, knowledge, skills and abilities will be considered
Billings Clinic is Montana’s largest health system serving Montana, Wyoming and the western Dakotas. A not-for-profit organization led by a physician CEO, the health system is governed by a board of community members, nurses and physicians. Billings Clinic includes an integrated multi-specialty group practice, tertiary care hospital and trauma center, based in Billings, Montana. Learn more atwww.billingsclinic.com/aboutus (https://www.billingsclinic.com/about-us/)
Billings Clinic is committed to being an inclusive and welcoming employer, that strives to be kind, safe, and courageous in all we do. As an equal opportunity employer, our policies and processes are designed to achieve fair and equitable treatment of all employees and job applicants. All employees and job applicants will be provided the same treatment in all aspects of the employment relationship, regardless of race, color, religion, sex, gender identity, sexual orientation, pregnancy, marital status, national origin, age, genetic information, military status, and/or disability. To ensure we provide an accessible candidate experience for prospective employees, please let us know if you need any accommodations during the recruitment process.