Under broad direction, the Director of Reimbursement is responsible for directing all government reimbursement activities for UC San Diego Health System. Manages all Federal and State cost reporting activities to insure that the Health System receives maximum reimbursement and cash flow consistent with Federal and State regulations. Prepare third party contractual allowance and prior year settlement schedules.

The Director represents the Health System to state and federal agencies, prepares appeals and negotiates settlements for government audit disputes. Provides expert reimbursement consulting assistance to executive leadership at the Health System and School of Medicine to promote financially sound decision making. Act as Medical Center liaison and consultant to the Office of the President on Medicare, Medi-Cal, and all supplemental Medi-Cal payment programs, Graduate Medical Education, HCAI, and Champus payment issues.

This role involves monitoring of reimbursement regulation changes and estimates the effect on the financial position of all entities of the UC San Diego Health including the Medical Center and Physician Group. Contributes to short and long range planning for reimbursement criteria, processes, tools and systems. Develops, modifies, and implements policies that affect reimbursement functions throughout the health system. Analyzes the potential impact on supplemental payments of proposed acquisitions and/or clinical program expansions. Oversees planning and implementation of Medicare and Medi-Cal supplemental programs totally in excess of $200M annually. Is responsible for oversight of over $1 billion of annual reimbursement from government payers.

Key Responsibilities:
* Works with senior leadership to develop and implement strategic plans and objectives for reimbursement across the health system. Ensures subordinate management meet performance metrics in order to achieve broadly stated objectives for medical center and physician group financial position.
* Oversees implementation of Medicare and Medi-Cal supplemental funding programs including the Medi-Cal waiver and subsequent replacement waivers, Medi-Cal DSH, Enhanced Payment Program (EPP), Quality Incentive Program (QIP), Rate Range, and AB915. Ensures cost reports and supporting analysis are prepared in a manner to maximize reimbursement to the Health system.
* Develops auditing policies and procedures to ensure compliance with applicable reporting requirements. Represents the health system in responding to discrepancies identified by audits for Medicare, Medical, and Financial Third-Party Administrators.
* Oversees the preparation of annual report to California Department of Healthcare Access and Information (HCAI) and ensures the LIUR reporting maximizes the Medical Center's ability to retain high DSH status.
* Calculates on a monthly basis the Medicare net revenue for the Medical Center of ~$700M and analyzes variance to budget.
* Prepares annual cash flow budgets for Medi-Care, Medi-Cal, and all supplemental programs for use in budgeting and long-term financial forecasting. Ensures all payments are appropriately posted. Assists the entity Controllers with proper revenue recognition under these programs including recognition of ~$200M in annual supplemental plan revenues.
* Analyzes the potential impact on supplemental payments of proposed acquisitions and/or clinical program expansions.
* Proposes staffing changes, justifying how staffing patterns meet timely charge capture, auditing, and reporting needs.
* Participates in the development of career series, defining development and growth consistent with workforce planning. Provides mentorship/leadership to managers and supervisors.
* Works with subordinate management to evaluate core competencies in Reimbursement personnel. Reviews and approves individual leadership/professional development plans, with succession planning needs in mind. Encourages all staff to develop financial and analytical expertise.
* Collaborates within and across departments to integrate Reimbursement services to optimally capture revenue and resolve charging issues.
* Oversees the annual forms to maintain medical center enrollment in federal and state funding programs. Develops strategies to capitalize on opportunities which entitle the Medical Center and Physician Group to additional program reimbursement.
* Reviews the potential financial impact of new, new, proposed and revised Federal and State healthcare laws and regulations and proposes operational plans to maintain compliance and maximize medical center and physician group financial position.
* Serves as local expert on government reimbursement and works collaboratively with peers across the University.

• Bachelor's degree in business, healthcare administration or related area, and eight or more years of relevant experience, or equivalent combination of experience, education and training.

• Experience and in-depth knowledge in healthcare reimbursement and financial analysis. Expert knowledge of Reimbursement trends in healthcare. Proven ability to apply theoretical concepts to define processes to meet department standards and organization goals.

• Progressive leadership experience

• Advanced degree in relevant area (Business, Finance, etc.)

• Ten or more years of relevant experience, including five or more years in formal leadership role.

• Must pass a background check.
• Must pass a pre-employment physical, drug screen and TB test.
• Must be able to work various hours and locations based on business needs.