Director Of Insurance Operations Jobs in Rhode Island

SUMMARY: Under the general direction of Vice President of Contracting and Payor Relations is responsible for the preparation of all third-party reporting and revenue estimates related to Brown University Health and affiliate reimbursement. Direct, control, and supervise all reimbursement duties. Brown University Health employees are expected to successfully role model the organization’s values of Compassion, Accountability, Respect and Excellence, as these values guide our everyday actions with patients, customers and one another. In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include: Instill Trust and Value Differences Patient and Community Focus and Collaborate In addition, our leaders will demonstrate an aptitude for: Ensure Accountability and Build Effective Teams Drive Vision and Purpose and Optimize Work Processes By applying core and leadership competencies, leaders help Brown University Health achieve its strategic goals. RESPONSIBILITIES: Prepare and assemble all financial and statistical individual, affiliate, and consolidated Brown University Health reports required by third party and governmental agencies for Brown University Health and affiliate reimbursements. Analyze financial and statistical data used in the individual affiliate reimbursement reports to determine accuracy, consistency from year to year, and effects upon Brown University Health reimbursements or final settlements. Verify and analyze rate calculations submitted by third party payors and governmental agencies for accuracy. Verify and analyze final cost settlements submitted by third party payors and governmental agencies for accuracy. Coordinate third party audits, defending preferential reporting practices. Prepare calculations projecting estimated Medicare rates of reimbursement. Adjust balances in both balance sheet and profit and loss statement to reflect current liabilities to/from third party payors at affiliate and system level. Analyze pass through payments as well as third party advances to determine if Brown University Health and affiliates are being underpaid or overpaid. Recommend and support areas where formal appeals to third party and governmental agencies are warranted. Maintain contact and close working relationship with Brown University Health's CPA firm and reimbursement consultants on reimbursement matters. Prepare monthly revenue and net accounts receivable estimates for all Brown University Health affiliates. Prepare special reimbursement studies regarding new programs. Keep Vice President of Contracting an Payor Relations informed on operations and events in the reimbursement area. Establish and maintain procedures for Reimbursement area to assure system-wide comprehensive and accurate data collection in full compliance with state and federal regulations. Establish and maintain procedures for accumulating accurate statistical data. Keep abreast of all standards to assure compliance with orders or directives issued by duly constituted governmental/regulatory agencies or third party payors. This covers such areas as financial reporting procedures, federal wage-price guideline, and development of data to meet proposed changes in governmental payment mechanisms. Interview, hire, and assign subordinate staff; provide guidance and counsel to subordinate staff; conduct periodic performance evaluations; recommend personnel actions; act as resource for staff; conduct periodic individual and/or group staff meetings; prepare and submit payroll; provide and maintain subordinate staff development plans; develop standards for subordinate staff performance. Maintain quality assurance, safety, environmental, and infection control in accordance with established system policies, procedures, and objectives. Participate in councils, quality improvement teams, and other such committees as required. Perform other related duties as required. MINIMUM QUALIFICATIONS: BASIC KNOWLEDGE: Bachelor's Degree in Accounting, Finance, or related field or equivalent. Comprehensive knowledge of accounting procedures, technical and professional accounting skills, financial and other operational systems to control data collection and reporting activities, and understanding of data processing procedures and capabilities. EXPERIENCE: Minimum of 5 years experience as a Manager or Director with experience in Month End Close, AR Valuation, Bad Debt, Settlement Roll-Forward, Medicare Cost Report Preparation, DSH, Medical Education, Appeals and Government relations. Broad experience in spreadsheet and database management applications. SUPERVISION: Function has supervision responsibility for up to 10 full-time equivalent personnel.

Pay Range:

$140,774.40-$232,273.60

EEO Statement:

Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.

Location:

Corporate Headquarters - 15 LaSalle Square Providence, Rhode Island 02903

Work Type:

(M-F 8:00am-5:00pm)

Work Shift:

Day

Daily Hours: 

8 hours

Driving Required:

No