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Manager of Reimbursement

University of Maryland Medical System Linthicum Heights Full-Time
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What You Will Do:

I. General Summary

Under general supervision manages the operations of the Reimbursement and Revenue Advisory Services Department of the University of Maryland Medical System. Manages, trains, recruits, coaches and develops reimbursement staff within his/her specialized function. Implements, reviews, and modifies all work related to reimbursement methodologies in compliance with HSCRC, federal, state, and local laws/regulations.

II. Principal Responsibilities and Task

The following statements are intended to describe the general nature and level of work being performed by people assigned to this classsification. These are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

1. Manages, trains and directs staff in accordance with departmental and UMMS personnel policies and procedures.
2. Supports strategic goals by gathering pertinent business, financial, service and operations information; identifies and evaluates trends and options; chooses a course of action; defines objectives; evaluates outcomes.
3. Communicates regularly with decision support, financial reporting, hospital departments, health information management (HIM), clinicians, UM School of Medicine, and others to ensure compliance of all regulations and optimal effectiveness of financial reporting.
4. Keeps abreast of current regulatory information/guidelines and coaches others to do the same; communicates relevant changes and/or protocol and procedural revisions to senior management and staff. Implements appropriate departmental operational changes to ensure compliance. Participates in HSCRC and industry meetings and workgroups.
5. Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
6. Coordinates external HSCRC and other regulatory audits to ensure that all information is available and completed on a timely basis.
7. Possesses an experienced and full knowledge and understanding of the skills necessary for the specific functional area in which they are assigned:
Specialization

The following statements are intended to describe the specialized skillset required to work in the defined functional area. People assigned to this classification are expected to have an intermediate to advanced knowledge/understanding of the skills listed.

Case Mix Oversight
1. Knowledge of case mix abstract data including how it is accumulated and processed, CMI analysis, and HSCRC quality programs such as MHAC, RRIP, & PAU.
2. Ability to aggregate/manipulate large datasets containing financial, demographic, utilization, and clinical data elements from disparate data sources using various Microsoft Access/Excel, SAS and Tableau data manipulation tools.
3. Ability to effectively communicate and present HSCRC case mix, quality and utilization technical information to a diverse groups including finance, clinicians, administration staff, and others within the industry.
Charge Description Master (CDM) Oversight
1. Knowledge of charge master components, coding and Epic charge master description application.
2. Ability to oversee the processes to establish, maintain and continuously update and monitor the accuracy of the charge master files in various hospital and clinical systems, including oversight of annual CPT and quarterly HCPCS updates, compliance to State and Federal billing / compliance regulations.
3. Knowledge and understanding of all charge processes within the organization and providing oversight to staff who assist other department managers/directors with determining chargeable services and appropriate CPT/HCPCS coding. Ensure clinical department staff comply with established charge capture and charge reconciliation policies and procedures.
Policy and Methodology
1. Initiates and develops new reporting and/or analysis of UMMS hospital performance on various HSCRC policies and methodologies to enhance revenue maximization and/or performance improvement opportunities.
2. Identifies opportunities and provides analytic and data support for system-wide Clinical Performance Improvement (CPI) strategic initiative.
3. Assists with the negotiation, financial analysis & reporting for risk contracts associated with UMMS Physician Quality Care Network (QCN).
Rate Setting
1. Knowledge and experience in HSCRC reimbursement, Maryland Healthcare Commission (MHCC), and HSCRC/Medicare Cost Reporting.
2. Ability to understand, interpret, measure and formulate financial models along with the development of UMMS’ strategies related to local and national reimbursement policy changes.
3. Ability to effectively communicate and present HSCRC rate methodology, quality and utilization, as well as technical information to a diverse groups including finance, administration staff, executives and other external stakeholders.
Research Billing Compliance
1. In collaboration with Sr. Manager and Director, develops management and operational systems that support the implementation of policies, procedures and standards that govern research activities in all UMMS business units.
2. Oversees the accurate addition of any and all appropriate modifiers, condition codes, diagnosis codes, etc. to identify patient charges on claims submitted to 3rd party payers, including Medicare, as part of an IRB approved clinical trial/research study.


IV. Education and Experience

1. Bachelor’s degree is required. Specialization in Healthcare, Finance, Accounting or equivalent related subject is preferred.
2. Four (4) years professional financial, reimbursement, or analysis experience is required.
3. Pervious supervisor or manager experience is preferred.
4. Healthcare-related finance background is preferred.

V. Knowledge, Skills and Abilities

1. Demonstrated knowledge of HSCRC reimbursement methodologies is required. Knowledge of state and federal reimbursement laws and regulations is required. Knowledge of ICD-10 and AMA Current Procedure Terminology (CPT) preferred. Proficiency in preparing and analyzing financial data and implementing changes to contain costs for budgetary purposes.

2. Effective at supervising, monitoring daily work activities, evaluating, training and motivating performance of subordinate technical, professional and clerical support staff.

3. Effective organizational and problem-solving skills are required to develop/implement efficient work processes and to successfully resolve difficult, conflict-oriented situations.

4. Highly effective verbal and written communication skills are necessary.

5. Highly proficient data analytic skills required. Ability to organize, combine, filter, and perform calculations on large datasets.

6. Highly effective computer skills that include the following applications: MS Excel, MS Word, and PowerPoint. Proficiency in Epic, MS Access, SAS, & Tableau is preferred.

7. Ability to handle confidential issues with integrity and discretion.

8. Ability to prioritize and manage work in a stressful environment.



What You Need to Be Successful:

IV. Education and Experience

1. Bachelor’s degree is required. Specialization in Healthcare, Finance, Accounting or equivalent related subject is preferred.
2. Four (4) years professional financial, reimbursement, or analysis experience is required.
3. Pervious supervisor or manager experience is preferred.
4. Healthcare-related finance background is preferred.

V. Knowledge, Skills and Abilities

1. Demonstrated knowledge of HSCRC reimbursement methodologies is required. Knowledge of state and federal reimbursement laws and regulations is required. Knowledge of ICD-10 and AMA Current Procedure Terminology (CPT) preferred. Proficiency in preparing and analyzing financial data and implementing changes to contain costs for budgetary purposes.

2. Effective at supervising, monitoring daily work activities, evaluating, training and motivating performance of subordinate technical, professional and clerical support staff.

3. Effective organizational and problem-solving skills are required to develop/implement efficient work processes and to successfully resolve difficult, conflict-oriented situations.

4. Highly effective verbal and written communication skills are necessary.

5. Highly proficient data analytic skills required. Ability to organize, combine, filter, and perform calculations on large datasets.

6. Highly effective computer skills that include the following applications: MS Excel, MS Word, and PowerPoint. Proficiency in Epic, MS Access, SAS, & Tableau is preferred.

7. Ability to handle confidential issues with integrity and discretion.

8. Ability to prioritize and manage work in a stressful environment.


We are an Equal Opportunity/Affirmative Action employer.  All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.
 

Skills required

Claims
Billing
Collections
Medicare
Insurance
Medicaid
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The University of Maryland Medical System (UMMS) was created in 1984 when the state-owned University Hospital became a private, nonprofit organization. It has evolved into a multi-hospital system with academic, community and specialty service missions reaching every part of the state and beyond.

UMMS is a national and regional referral center for trauma, cancer care, neurocare, cardiac care, women's and children's health and physical rehabilitation. It also has one of the world's largest kidney transplant programs, as well as scores of other programs that improve the physical and mental health of thousands of people daily.

The Medical System generates nearly $3.5 billion in economic activity in Maryland. It has 15,000 employees, approximately 2,300 licensed beds, 115,000 annual patient admissions and gross patient revenues of $2 billion.

Member Hospitals

The hospitals and health systems that comprise UMMS are:

    University of Maryland Medical Center- One of the nation's oldest teaching hospitals, this 816-bed facility -- located in downtown Baltimore -- is home to the University of Maryland Marlene and Stewart Greenebaum Cancer Center, the R Adams Cowley Shock Trauma Center, the University of Maryland Children's Hospital and the University of Maryland Division of Transplantation.

    University of Maryland Medical Center Midtown Campus - This 208-bed teaching hospital offers a full spectrum of health care for more than 110,000 people annually. University of Maryland Medical Center Midtown Campus has been providing superior and accessible community health care in West Baltimore and Midtown for more than a century.

    Mt. Washington Pediatric Hospital - This 102-bed pediatric and rehabilitation hospital, located in northwest Baltimore, provides specialty medical care to infants and children with complex medical needs.

   UM Baltimore Washington Medical Center - This 319-bed community hospital, located between Baltimore and Annapolis in Anne Arundel County, offers a wide variety of services and was recently named a "Top 100" hospital for intensive care outcomes by Thomson Reuters.

    UM Charles Regional Medical Center - Located in La Plata, Maryland, this 110-bed community hospital, along with an Ambulatory Surgery Center and OB/GYN Centers in Waldorf and La Plata, serve patients in Charles County and the surrounding areas of southern Maryland.

    UM Rehabilitation and Orthopaedics Institute - This 141-bed facility (formerly Kernan Hospital), located in Woodlawn, is the state's largest rehabilitation and orthopaedic hospital serving both adults and children. It also houses the University of Maryland Complementary Medicine Program.

   UM St. Joseph Medical Center - This 232-bed nonprofit, regional medical center, located in Towson, Md., became a part of the University of Maryland Medical System on December 1, 2012. It features institutes for heart, cancer and orthopaedic care, and offers a full range of clinical diagnostic and treatment services.

   UM Shore Regional Health - Shore Health System became UM Shore Regional Health on July 1, 2013, and consists of the following facilities: UM Shore Medical Center at Chestertown; UM Shore Medical Center at Dorchester and UM Shore Medical Center at Easton, as well as the UM Shore Emergency Center at Queenstown.

   Upper Chesapeake Health System - In July 2009, UMMS announced a strategic affiliation with Upper Chesapeake Health System that is expected to lead to a full merger. Upper Chesapeake Health includes Upper Chesapeake Medical Center in Bel Air and Harford Memorial Hospital in Havre de Grace. The leading health care system and largest private employer in Harford County, Upper Chesapeake Health offers a broad range of healthcare services, technology, and facilities to the residents of northeastern Maryland.

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