General Summary: In conjunction with the Sr. Director of Finance, this position serves as a resource for assisting the CPA Finance Department, The Office of Managed Care, JHU Departments, and JHM leadership, with third party payer contract rate negotiations, revenue budgetary projections associated with payers, governmental reimbursement and coding financial impacts, and other payer related issues for Johns Hopkins Medicine. This position monitors proposed and finalized federal and state governmental payment rates, coding updates, and methodology changes and provides input to legislative groups, the Finance Department, operations, and leadership to formulate and adopt strategies for success and continuous improvements.
This position works jointly with the CPA Finance Department, leadership and the Office of Managed care in organizing, implementing and managing projects assigned to enhance revenue opportunities and provide internal review, and verification support for external consultant engagements and is a resource for internal contracting committees. Benchmarking initiatives, payer metrics including third payer payments as a percentage of Medicare, service line analytics, site-of-service reviews, and other projects as assigned.
The position participates in the development and modifications relative to the CPA developed SMART contracting and variance reporting system or replacement systems and requires an in-depth analytical self-directed initiative and full understanding of billing operations and payment methodologies for accurate analytics are required.
Principal Duties and Responsibilities: Procedural Knowledge: • Retain a comprehensive knowledge of the complex insurance payment methodologies, regulations, laws and contracts affecting the revenue operations related to patient service revenues in the CPA • Maintain financial and billing systems knowledge to assist CPA Finance with providing payer benchmarking data files, project support, and to insure revenue opportunities are appropriately maximized; • In coordination with the CPA Finance Department and the Office of Manage Care, maintain knowledge used to assess revenue impacts of new procedures, treatments, and site-of-service initiatives; • Assist CPA Finance and Office of Managed Care in assessing settlements with insurance carriers to resolve reimbursement inequities. • Assist in the review of Third Party Vendors to insure accuracy of information provided to Executive Leadership, CPA Finance, and the Office of Managed Care. • Help to monitor and analyze payment variance to detect contract payment discrepancies and/or operational errors. • Prepare analytical reviews as assigned for the CPA Senior Director, Revenue Operations, Office of Managed Care and executive Leadership of JHSOM. • Support patient service revenue committees to address reimbursement issues and provide recommendations related to changes required from insurers, including interpretation of regulatory issues, and financial implications. • Assist in the review of new products/software and further functional development of the CPA SMART System or contract management systems to incorporate insurance carrier changes in reimbursement methodology, expand variance and contract modeling reporting capabilities. • Assist in the maintenance of providing and monitoring accurate fee schedules and reimbursement policies in the CPA SMART System for all medical specialties and all JH Medicine contracts. • Develops meaningful reports and tools to illustrate payer performances including payers as a percentage of Medicare analyses. • Provides assistance to the CPA Senior Director of Finance in the form of financial and statistical reports, data analysis, consultation, planning and management of the financial operations of the CPA as part of JH Medicine as it relates to payer performance.
Duties and Responsibilities (Finance): • Review third party payer contract rates and assist CPA Finance and the Office of Managed Care in identifying opportunities and analyzing proposed counter rates throughout the process. • Utilize benchmarking information to assess payer market comparisons, trends, contract opportunities, and contract shortfalls. • Assess departmental, service line, and site-of-service, patient service revenue impacts from third party contractual changes and proposals. • Review annual proposed and final governmental regulatory changes and provide financial implications of these changes. • Participate in optimizing charging rates to enhance appropriate payments, maintain cost/charge relationships for improved patient satisfaction and increased consistency across departments. • Continually look for patient service revenue opportunities. • Establish procedures, measures and reporting tools to enhance payer information and metrics. • Assist with budgeting process as it relates to patient service revenue Reimbursement changes. • Develop, organize, implement and manage projects assigned to enhance appropriate patient service revenue maximization for the CPA as part of JH Medicine.
Technical Knowledge: • Comprehensive knowledge and compliance of HIPAA rules and regulations in the dissemination of patient Protected Health Information (PHI). • Utilize online resources including EPIC, Cognos, Smart, and other systems to facilitate analysis. • Requires a thorough understanding of medical billing reimbursement in a high volume medical services environment. • Excellent communication and collaborative skills with the ability to work well under pressure.
Professional & Personal Development: • Participates in on-going educational activities. • Keeps current of industry changes by reading assigned material on work related topics. • Maintains certifications and completes training as needed.
• Must adhere to Service Excellence Standards.
o Customer Relations
o Continuous Performance Improvement
Core Values: • Diversity. Be open. Embrace and value different backgrounds, opinions, and experiences. • Excellence and Discovery. Be the best. Commit to exceptional quality and service by encouraging curiosity, seeking information, and creating innovative solutions. • Leadership and Integrity. Be a role model. Inspire others to achieve their best and have the courage to do the right thing. • Respect and Collegiality. Be kind. Listen to understand and embrace others’ unique skills and knowledge.
Supervision of Others: Works cooperatively with others and promotes proactivity, excellence, and inclusivity both internally and externally.
REQUIREMENTS: Education: • Bachelor’s degree in accounting, finance or other related degree field required. Master’s degree preferred. Additional job related experience beyond minimum experience qualifications may substitute for formal education requirement to extent permitted by JHU equivalency formula.
Experience: • Seven years of progressive responsibility and experience required. • Knowledge of federal and state government, third party, and enrollment regulations. • Comprehensive knowledge of complex insurance regulations and laws for facility and physician billing. • Experience in an academic medical environment is preferred. • Must possess strong interpersonal skills including strong negotiation skills; strong analytical skills; strong written and oral communication skills and ability to work collaboratively. • Must possess strong PC, analytical and coding skills. • Must possess ability to exercise a high degree of initiative, judgment, discretion and decision making to achieve organizational objectives. • Knowledge of medical billing and collection applications required. • Experienced user of Microsoft Excel, Word and PowerPoint. Tableau experience preferred. • SMART system knowledge and experience preferred. • EPIC Resolute system ProFee billing system knowledge and experience preferred. • Cognos system knowledge preferred. • Strong organizational skills and capability of meeting deadlines and working well under pressure is required. Additional education beyond minimum experience qualifications may substitute for required experience to the extent permitted by the JHU equivalency formula.
Minimum Skills & Abilities: Able to operate basic office equipment, e.g. photo copier, fax machine, scanner, PC, telephone, etc.
Physical requirements for the job: • Able to sit in a normal seated position for extended periods of time. • Finger dexterity required, able to manipulate objects with fingers rather than entire hand(s) or arm(s), e.g., use of computer keyboard. • Able to communicate using the spoken and written word. • Able to see within normal parameters and to hear within normal range. • Able to lift minimum weight, 10 lbs.
Classified Title: Assistant Director Finance Working Title: Assistant Director Finance Role/Level/Range: ATP/04/PF Starting Salary Range: $80,665- $110,880 annually Employee group: Full Time Schedule: M - F, 8:30 am - 5:00 pm Exempt Status: Exempt Location: 20-MD:JH at Franklin Square Department name: 10002653-SOM Admin CPA Finance Personnel area: School of Medicine
The successful candidate(s) for this position will be subject to a pre-employment background check.
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