Summary:

The Associate Director ensures accurate and appropriate government payor reimbursement-related calculations and estimates and ensures UTMB compliance with Medicare and Medicaid regulations.

 

Scope: Institutional

Responsibilities:

Responsible for technical aspects, calculations and analyses of multiple areas of Medicare and Medicaid reimbursement components including, but not limited to, cost report preparation, audits, re-openings, appeals, IME, DGME, DSH, UC, Organ Acquisition, Bad Debt, Wage Index, Physician Time Studies, Paramedical Education Time studies and Provider Enrollment, and directs departmental employees in these areas. Ensures accuracy of Medicare, Medicaid and TDCJ cost report tentative and final settlements, communicates problems to Medicare and Medicaid contractors and directs departmental employees in handling related issues. Directs preparation and ensures accuracy of monthly Medicare, Medicaid and TDCJ settlement account estimates and directs preparation of related third-party audit support. Manages external audits, resolves audit issues and responds to inquiries from external auditors, such as Medicare, Medicaid, State and OIG auditors. Responsible for state/Medicaid supplemental payment applications and audits and for directing staff in preparation of these reports. Supports Director, Finance-Government Reimbursement in preparing annual Medicare, Medicaid and TDCJ net revenue budget rates. Represents the Government Reimbursement department on various committees and task force groups. Maintains current knowledge of Medicare reimbursement and cost reporting regulations, keeping abreast of recent changes that may affect the department’s policies and procedures, and takes necessary actions to implement appropriate processes and procedures to ensure compliance with Medicare and Medicaid regulations. Supports Director, Finance-Government Reimbursement in preparing and monitoring departmental budget. Participates in recruitment, hiring, orientation, training, supervision, evaluation, disciplinary action and/or termination process, as needed, within department. Performs related duties as assigned. 

Minimum Qualifications:

Bachelor's degree in accounting, business or related field plus eight (8) years of Medicare and Medicaid reimbursement experience to include four (4) years of reimbursement supervisory experience.

 

Preferred Qualifications:

Master's degree in accounting, CPA or business plus eight (8) years of Medicare and Medicaid reimbursement experience to include four (4) years of reimbursement experience at manager level or above. Experience with Medicare IME, DGME, DSH and Organ Acquisition reimbursement and experience with Texas Medicaid and state supplemental payment methods.

Equal Employment Opportunity

UTMB Health strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. As a Federal Contractor, UTMB Health takes affirmative action to hire and advance protected veterans and individuals with disabilities.

Compensation