Senior Vice President, Government Payment Policy and Net Revenue
The SVP of Government Payment Policy and Net Revenue reports to the Corporate CFO. This SVP will lead a senior team responsible for Government functions for the Steward Health System. The SVP will lead the development of long- and short-term Medicare, Medicaid, and other government reimbursement revenue strategies, oversee preparation and submission of all regulatory filings, and partner with Policy and Government Relations leadership, as well as outside consultants, also to optimize State supplemental payment opportunities. The SVP is responsible for overseeing enterprise-wide AR valuation methodologies and for developing and implementing new tools, models, and approaches to revenue analysis with an aim toward improving actionable information, increasing reliability and predictability, and improving efficacy. The SVP will be responsible for overseeing the annual revenue budgeting process, ensuring the efficiency and accuracy of month end close activities, and completing standard and ad hoc revenue analytics.
- Demonstrated ability to build and foster a cohesive team of reimbursement and financial analysts responsible for supporting corporate, regional, and local financial and operational leadership
- Experience working with senior-level internal and external stakeholders to innovate and optimize reimbursement strategies in support of Steward’s physician-led model focused on advancing high quality, affordable patient care
- Seasoned professional that has a deep understanding of health care operations and finance and reimbursement payment models.
- Demonstrated expertise in reimbursement and data analytics with the ability to conduct root cause analysis and provide actionable insights to operators and senior leaders
- Experience working with internal and external auditors on AR valuations, third-party settlements, and other financial reviews
- Responsible for all aspects of third-party government payor reimbursement functions for the health system. This includes Medicare, Medicaid, and other Governmental Cost Report filings/audits/appeals, State provider supplemental reimbursement and staying current on all Federal and State government regulatory payment changes
- Oversees strategic reimbursement initiatives, including Medicare and Medicaid DSH, GME, UC, bad debt reimbursement, and wage index reclassifications
- Evaluates all medical education reimbursement calculations, which includes scrutinizing all roll forward calculations, affiliation agreements, and residency caps
- Experience in Medicaid Hospital-Specific Limit (HSL) and Upper Payment Limit (UPL) calculations and supplemental payment methodologies
- Reviews all Medicaid and Medicare data to determine Medicare disproportionate share reimbursement
- Reviews all third-party settlements to ensure their accuracy and standardize their presentation
Net Revenue/AR Valuations
- Maintains enterprise-wide AR valuation methodologies at the direction of the CFO
- Manages relationships with key vendors to ensure these partnerships fulfill Steward’s AR valuation and reimbursement requirements
- Works cross-functionally with decision support, FP&A, finance, and others to develop and implement a robust net revenue analytics solution that can be leveraged by system, regional, and local finance leadership
- Provides oversight of hospitals’ month end close methodologies and AR valuations. Includes the ability to analyze trends impacting reserves including payor mix, accounts receivable aging, etc.
REQUIRED KNOWLEDGE & SKILLS:
- Comprehensive knowledge of all government reimbursement-related regulations, hospital reporting requirements, and net revenue analytics.
- Working knowledge of hospital accounting, patient accounting procedures, and specific rules governing reimbursement for different hospital services
- Proven problem-solver with the interpersonal skills to work with people at all levels both inside and outside the system
- Communicates effectively both verbally and in writing
- Well-organized with great attention to detail and the ability to coordinate multiple tasks under tight deadlines
- Takes direction well and has the ability to work independently
- Education: Bachelor’s Degree in either business or financial-related field. A Master’s Degree in business, finance, or healthcare-related field is strongly preferred
- Experience (Type & Length): 15+ years’ experience in healthcare finance, reimbursement, or healthcare consulting is required
- Certification/Licensure: Masters in Business Administration or related field is preferred
- Software/Hardware: Must have working knowledge of Microsoft Excel, Microsoft Access, Microsoft Word, KPMG Cost Reporting/GME software (or similar), and Meditech
- Other: Ability to assume responsibility without direct supervision. Ability to maintain a high level of confidentiality
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal ability to furnish information. 41 CFR 630-1.35.