Vice President - Revenue Advisory Services

I.                   General Summary

The Vice President of Revenue Advisory Services is responsible for the reimbursement function of the System. The position is accountable for strategic rate setting and revenue advisory services to System Chief Financial Officer, and is accountable for financial reimbursement analyses, charge capture and charge master procedures,  HSCRC and CMS regulatory reporting including Pay for Performance and Quality Based Reporting, Payor Contracting and financial analysis of Value-based care arrangements.

The Vice President is also responsible for the establishment of goals, objectives, and standards of performance; development and implementation of operating policies and procedures; interpretation and insurance of compliance with relevant policies and procedures, standards, regulations and codes to personnel.

II.                Principal Responsibilities and TasksThe following statements are intended to describe the general nature and level of work being performed by people assigned to this classification.  They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

1.                  Oversees the operations of the department while applying hospital policies and procedures as well as federal, state, and local statues or regulations governing general financial practices to ensure accurate and effective service.

2.                  Provides reimbursement and revenue strategic advisory services to System CFO:

A.                Develops strategies to improve HSCRC reimbursement and develops new reimbursement strategies to maximize reimbursement.

B.                 Provides analysis and insight into HSCRC reimbursement methodologies.

C.                 Educates management on reimbursement topics and issues.

D.                Negotiates with the State and Federal regulatory agencies to implement new reimbursement policies and methodologies.

E.                 Primary liaison with the HSCRC and CMS on methodology issues.

F.                   Negotiates annual rate and global budget adjustments with the HSCRC to ensure maximum HSCRC approved revenue.

3.                  Accountable for and leads the rates and reimbursement function for all System hospitals:

A.                Ensures hospital pricing achieves maximum revenue allowed while ensuring compliance to all federal and state billing regulations.

B.                 Reports monthly financial statement revenues for each facility.

C.                 Develops annual revenue budgets and the revenue assumptions for the five year strategic plan.

D.                Ensures accurate and timely preparation of all state and federal mandated regulatory disclosures including but not limited to HSCRC Annual filings, Medicare Cost Reports, and other data as required.

E.                 Directs the analysis and reporting of the inpatient and outpatient case-mix issues related to rate-setting methodologies of the HSCRC.

4.                  Accountable for monitoring, reporting and driving performance of the Revenue Cycle Management Function for the System.

5.                  Accountable for development and implementation of Payor strategies to maximize payments for contracted services

A.                Ensures the charge master complies with federal and state billing and regulatory requirements.

B.                 Communicates with clinical departments to ensure compliance to charge capture policies and procedures.

C.                 Monitors clinical departments’ charge practices and volume levels.

D.                Oversees monthly reporting of revenue and statistics both internally and externally.

6.                  Utilizing expertise in current regulatory (HSCRC & CMS) information/guidelines to maximize strategic outcomes; communicates relevant changes and/or protocol and procedural revisions to senior management and staff.  Implements appropriate departmental operational changes to ensure compliance.

7.                  Accountable for communicating strategic and financial information to the highest levels of the organization including the Board of Trustees and senior management.

III.       Education and Experience

1.                  Bachelor’s Degree from an accredited college or university in Accounting, Finance, or related field.  Master’s in business administration is preferred.

2.                  Ten years progressively responsible professional HSCRC or CMS reimbursement experience, or equivalent, is required.  In addition, eight years supervisory/management experience is required.

IV.       Knowledge, Skills and Abilities

1.                  Expert knowledge of HSCRC and Medicare regulations is required. 

2.                  Highly proficient mathematical and analytical skills are required. Proficiency in analyzing and presenting strategic and financial information to the highest levels of the organization.

3.                  Ability to operate a personal computer and utilize Microsoft Office products.

4.                  Proficient knowledge of supervising, monitoring daily work activities, evaluating, training and motivating the performance of professional support staff.

5.                  Proficient organization and problem-solving skills are required to develop/implement efficient work processes, and to resolve difficult, conflict-oriented situations.  Ability to work effectively in a stressful work environment.  Ability to handle confidential issues with integrity and discretion.

6.                  Highly effective verbal and written communication skills are necessary to work with senior management, state rate regulators, federal regulators and clinical and financial department heads.